bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective immunization against influenza in pediatric renal transplant recipients
Authors: Edvardsson Vidar O. , Flynn Joseph T. , Deforest Adamadia , Kaiser Bruce A. , Schulman Seth L. , Bradley Alicia , Palmer JoAnn , Polinsky Martin S. , Baluarte1 H. Jorge 
Published: September 2024

AbstractViral infections such as influenza are an important cause of morbidity following organ transplantation. We evaluated the immunogenicity of a commercially available influenza vaccine in pediatric renal transplant recipients in a two‐phase, prospective study. In phase one, 47 transplant patients and seven control subjects with bronchopulmonary dysplasia received influenza vaccine. Sera were collected at the time of vaccination and 6 wk later. In phase two, sera from 18 transplant recipients and 47 healthy adults who had received the same vaccine were collected 6‐12 months after vaccination. Antibody titers to the A/Taiwan/1/86 antigen were measured with a hemagglutination inhibition assay in both phases of the study. Vaccine was well tolerated in all subjects. No vaccinated patient required hospitalization for complications of influenza infection. Vaccination did not increase the frequency of acute allograft rejection. In phase one, 43 patients (91%) and 5 controls (71%) either seroconverted (developed a fourfold or greater rise in titer), or developed post‐vaccination titers ≥1:160 (p=NS). Among the transplant recipients, non‐seroconverters had a higher pre‐vaccination geometric mean antibody titer (GMT) than those who seroconverted. Seroconversion developed independently of whether patients received double or triple immunosuppression. In phase two, post‐vaccination GMT were similar for patients and control subjects at 11.5 and 8 months post‐vaccination, respectively. In our study, influenza vaccination produced equivalent humoral immunity in transplant recipients and normal subjects. Routine influenza vaccination should be performed annually in this high‐risk population.
Cutaneous squamous cell carcinoma metastatic to the parotid gland in a transplant patient
Authors: Christiansen Timothy N. , Freije James E. , Neuburg Marcelle , Roza Allan 
Published: September 2024

AbstractParotid metastases from cutaneous neoplasms are rare and have a relatively good prognosis if limited to the lymph nodes. When extension beyond the lymph nodes occurs, prognosis is grave. It has also been reported that transplant patients have a higher incidence of cutaneous carcinoma, which tends to be more aggressive. We report a case of an aggressive squamous cell carcinoma metastatic to the parotid gland in a liver transplant patient. The literature pertaining to parotid area metastasis and cancer in transplant recipients is reviewed. We conclude that clinicians should have a higher clinical index of suspicion for cutaneous lesions in transplant patients and that cutaneous lesions at risk for metastasis to the parotid should be treated more aggressively.
Repeated HLA mismatches and second renal graft survival in centers of the South‐Eastern Organ Procurement Foundation
Authors: Heise Eugene R. , Thacker Leroy R. , MacQueen J. Marilyn , Peters Thomas G. 
Published: September 2024

AbstractTo determine if repeated HLA mismatches and other putative risk factors were predictive of second graft failure in second grafts performed at Southeastern Organ Procurement Foundation (SEOPF) member centers, we identified a cohort of 753 retransplants in which one or more HLA antigens were mismatched in primary grafts. Of this group, 158 (21.1%) received second grafts with repeated mismatches of one or more HLA‐A, B, or DR antigens that were previously mismatched in the primary graft (RMMs). All regrafts were cadaveric kidneys transplanted between 1982 and 1995. Multivariate analysis of 19 covariates in 438 regrafts identified four independent factors that were predictive of graft survival frequency in second transplants. Three of the four factors were associated with a reduced risk for graft loss in retransplants: cyclosporin A (CSA) use in regrafts (p=0.0001, RR=0.26), peak PRA<50% (p= 0.008, RR 0.52) and white donor race (p=0.035, RR=0.63). One factor was associated with an increased risk of second graft failure, namely, blood transfusion prior to the first graft (p=0.026, RR=5.14). None of the other 15 factors exerted significant additional risk to regraft survival frequency in these SEOPF data. In multivariate analysis, RMMs were not associated with altered graft survival frequency in regrafts (p=0.944, RR=0.99). We then used univariate analyses to determine whether RMMS had adverse effects on GS in particular subsets of recipients that were thought to be at increased risk for the second transplant failure. Univariate analyses were performed with methods that are sensitive to early events (Wilcoxon) and late events (log‐rank). The variables tested were CSA use for the regraft, duration of primary graft function, panel reactive antibody levels (PRA), immunopathologic cause of first graft failure, and HLA mismatch of the second graft. These analyses indicated that repeated HLA mismatches were not an associated risk factor in any of these subgroups. These SEOPF data indicate that RMMs are not predictive of increased frequency of graft loss in cadaveric donor second transplants. We conclude that our results do not support a policy of routine avoidance of RMMs, which may result in increased waiting time for a second donor without providing an improved graft survival rate. The available literature suggests that HLA antibody identification, the use of sensitive flow cytometric and antiglobulin‐augmented cross‐match tests, together with appropriate donor selection, optimal immunosuppression and patient management may be sufficient to avoid the early loss of second grafts.
Flow cytometry crossmatching and primary cadaver kidney graft outcome: relevance of T and B cell targets, historic sera and autologous controls
Authors: LeFor William M. , Ackermann John R. W. , Alveranga Denise Y. , Bowers Victor D. , Heinrichs Dennis F. , Kahana Lawrence , Shires Dana L. , Weinstein Samuel S. , Wright Charles E. 
Published: September 2024

AbstractThere is limited information regarding the role of flow cytometry crossmatching (FCXM) in primary cadaver kidney allografting and even less about B cell reactivity and graft survival (GS). Furthermore, there is little or no published data concerning reaction strength (cutoff value), the effect of historic sera reactions, and the usefulness of performing autologous crossmatches (XMs) on GS. These factors were examined retrospectively on 214 primary transplants performed from August 1991 to January 1994 with follow‐up to July 1995. Three‐color FCXMs were done on a 1024‐channel BD‐FACScan, and the shift in median channel fluorescence (MCF) over the negative control was calculated. All patients had a negative T cell (AHG) and warm B cell (2 wash, extended incubation) cytotoxicity XM, and none was excluded in calculating GS. A quantitative effect was noted as stronger MCF shifts vs. T or B cells correlated with decreased GS (r=0.98 and 0.92, respectively). Significant differences were seen with cutoff values of T=50 and B=110 which were 1.7‐1.8 times the SD above the mean MCF of normal sera controls. T neg patients (n=198) had 1‐ and 3‐yr actuarial GS of 86% and 79% compared to T pos patients (n=16) of 75% and 49%, p=0.008. B neg patients (n=177) had 1‐ and 3‐yr GS of 86% and 81% compared to B pos patients (n=37) of 78% and 47%, p=0.005. Most informative was the analysis of combined T and B cell FCXM results. Three year GS for T neg B neg patients (n=171) was 81%, and for T pos‐ B neg patients (n= 6), it was 83%, p=0.98. The 27 T neg ‐ B pos group's GS was lower at 62% but did not reach significance. Poorest GS was seen for T pos‐ B pos patients (n=10) at 23%, p=0.0001. Reaction patterns showed that T cells detected only HLA Class I antibodies, whereas B cells detected both Class I and II. Historic sera (≥1 month old) reactivity influenced GS. Patients with ≥2 past sera positive but current serum negative reactions vs. T or T plus B cells (n=7) had a poor 29% GS, while those historically positive only vs. B cells (n=7) had 100% GS. On the other hand, patients positive only with the current serum (n=16) had 2‐yr GS of 100% (false positive test?), while patients whose current and historic sera reactions were positive (n=21) had a 25–50% GS (true positive test?). About 1 in 5 patients (19%) displayed positive autologous FCXM reactions. Subtraction of autologous MCF shift values from those vs. the donor converted 17 patients to the T neg B neg or T pos B neg group whose 2‐yr actual GS was not significantly different (p>0.8) from those initially testing T neg B neg vs. their donors.
Donor‐specific HLA antibodies after transplantation are associated with deterioration in cardiac function
Authors: Leech Stephen H. , Mather Paul J. , Eisen Howard J. , Pina Ileana L. , Margulies Kenneth B. , Bove Alfred A. , Jeevanandam Valluvan 
Published: September 2024

AbstractAlthough there is increasing evidence that mismatched donor HLA antigens are associated with a lowering of survival of human cardiac allografts, the effect of antibodies that bind those antigens is less clear. The existence of lymphocytotoxic antibodies prior to cardiac transplantation has been associated with a poor outcome in the majority of reports of relevant studies, as has their appearance post‐transplantation. But how such antibodies, especially those with HLA specificity, cause poor outcomes has been poorly understood. The purpose of this study was to investigate the effect of anti‐HLA antibodies appearing in the circulation after human orthotopic heart transplantation. Such antibodies were identified by a standard microlymphocytotoxicity technique using panels of frozen lymphocytes from normal donors who had been tissue typed. Of 74 patients transplanted over a 12‐month period, 4 (5.4%) developed alloantibodies specific for mismatched donor HLA antigens. The first patient developed antibodies to HLA‐A23 and B44 together with poor ventricular function and vascular rejection requiring retransplantation within 4 months. The other patients (3) developed antibodies specific for HLA‐DQ antigens and experienced variable numbers of episodes of cellular rejection with no evidence of vascular rejection on endomyocardial biopsy. Two of these three patients died (8 and 11 months post‐transplant) after three and six rejection episodes, respectively. The one surviving patient had seven rejection episodes and continues to have poor ventricular function 18 months post‐transplant. We conclude that alloantibodies specific for mismatched donor HLA antigens may have a deleterious effect on the outcome of the human cardiac allograft and should be monitored closely post‐transplant. Furthermore, such antibodies may mediate effects on the transplanted heart which are not detectable in specimens obtained by endomyocardial biopsy.
A new approach for increasing the organ supply
Authors: Kowalski Anne E. , Light Jimmy A. , Ritchie William O. , Sasaki Truman M. , Callender Clive O. , Gage Fred 
Published: September 2024

AbstractThe donation of organs and tissues for the benefit of another person is an altruistic act and one that is a guaranteed option for the next‐of‐kin through various national Required Request legislations. At the Washington Hospital Center we have developed an approach that permits organ recovery from non‐heart beating donors. The focus is on victims of fatal trauma and assures that each family is empowered with the right to make a donation decision. In October 1993 a consensus conference was held on implementing a program to recover organs from fatal trauma victims. The participants recommended that safeguards be incorporated to assure ethical treatment of both the trauma victim and the nextof‐kin. An Office of Decedent Affairs (ODA) was then established and implemented in September 1994. The ODA is staffed by Family Advocates who are on duty continuously and respond to all trauma and death. events. Their mission is to consolidate all death events, provide support to decedent families, assure that required request mandates are fulfilled, interact with the local Organ Procurement Organization (OPO) in the consent process, and facilitate the implementation of the Rapid Organ Recovery Program (RORP). The RORP consists of two specific procedures: cannulation of the femoral arterial‐venous system for flushing the kidneys with a preservative solution, and intubation of the peritoneum for in situ cooling using an ice/lavage process. In the 1‐yr period since the ODA was established, organ and tissue donation has increased by more than 300%.
Prevention of hepatitis B recurrence with indefinite hepatitis B immune globulin (HBIG) prophylaxis after liver transplantation
Authors: Nymann Trine , Shokouh‐Amiri M. Hosein , Vera Santiago R. , Riely Caroline A. , Alloway Rita R. , Gaber A. Osama 
Published: September 2024

AbstractLiver transplantation for hepatitis B is followed by a high rate of recurrence some time after transplantation, resulting in poor outcome compared to liver recipients transplanted for other indications. Passive immunoprophylaxis with HBIG has been shown to decrease the rate of recurrence to 25–50%, but the intensity and length of treatment is still controversial. We studied 17 HBsAg positive patients who were transplanted for hepatitis B. Four did not receive immunoprophylaxis and they all reoccurred within 3 months. The remaining 13 have received indefinite, high dose HBIG (10 000 u or 40 000 u/dose depending on HBV DNA status pretransplant). Ten of 13 patients (77%) remain HBsAg negative after a mean follow‐up of 16.7 months with six of these ten patients being HBV DNA positive pretransplant. Of the three who have experienced recurrence, two received extensive additional immunosuppression beyond that normally administered to transplant patients (chemotherapy, multiple antirejection treatment). The last patient received 110 000 u of HBIG during the first 3 months, which produced an anti‐HBs titer level of 225 IU/L, but the following month he was HBsAg positive with an anti‐HBs titer of 13 IU/L. We conclude that HBsAg positive patients can be safely transplanted using indefinite, high‐dose HBIG prophylaxis. and that with adequate HBIG it is possible to prevent recurrence in HBV DNA positive patients as well.
Liver transplantation for alcoholic liver disease
Authors: Zibari G. B. , Edwin D. , Wall L. , Diehl A. , Fair J. , Burdick J. , Klein A. 
Published: September 2024

AbstractOrthotopic liver transplantation (OLT) for individuals with alcoholic liver disease (ALD) remains controversial. This review was designed to evaluate the survival, recidivism, and rehabilitation of the alcoholic liver transplant recipient in a single transplant center. Methods: Between 10/86 and 11/92 203 liver transplants were performed in 179 patients. In 42 patients (23%) the primary etiologic diagnosis was ALD (36 males, 6 females, median age 47 yr). All ALD patients were evaluated preoperatively by social service, psychiatry, and medical psychology, in addition to hepatology and transplant surgery. A minimum abstinence period of 3‐6 months was encouraged, although exceptions were made for cases of extreme medical urgency in which a good prognosis for abstinence was predicted. Results: In OLT recipients with ALD, actuarial survival at 1, 2, and 3 yr was 74%, 71%, and 71%, respectively, compared to 71%, 71%, and 69% for all OLT recipients. Oneand two‐year survival was 85% in the most recently transplanted 86 patients, 20 of whom (23%) had ALD with 1‐ and 2‐yr survival of 84% (N.S.). Recidivism was monitored postoperatively by interviews with the patient and family, supplemented by random urine and serum toxicology. Of the 29 survivors, 2 (7%) returned temporarily to alcohol use but are presently abstinent. Although none of the ALD patients in this study was able to work prior to OLT, 76% of the survivors at least 4 months post‐transplantation were employed. Conclusions: Although our experience is small, our results suggest that OLT is appropriate therapy for carefully selected patients with endstage liver failure due to ALD. The multi‐disciplinary approach to preoperative evaluation of the alcoholic liver transplant candidate is effective in determining those patients committed to abstinence after a successful transplant.
Is matching for sex and age beneficial to kidney graft survival?
Authors: Busson M. , Benoit G. ,   Société Française de Transplantation and Association France Transplant
Published: September 2024

AbstractA total of 6889 cadaver kidney grafts carried out in the French transplant network from 1 January 1989 to 31 December 1992 were analyzed using single and multifactorial methods in order to evaluate the impact on graft survival of matching for sex and age between donors and recipients. The mean graft survival rate was 75% at 3 yr with donors between 10 and 50 yr of age compared to 65% for donors under 10 yr of age. and 67% at 3 yr for donors over 50 yr of age (p <0.000001). For child recipients there were no significant differences in graft survival whatever the difference in age with the donor (± 10 yr). For young adults (17–49 yr of age) the prognosis at 3 yr was the same (75%) whether the donor was in the same age category or older than the recipient. For older adults (> 50 yr of age) a poorer prognosis was obtained when the donor was 10 yr or more older than the recipient (61% at 1 yr, p=10−4). The grafts performed with male donors had a better prognosis (76% at 3 yr) than those using female donors (71% at 3 yr, p <0.0002). The poorest results were obtained with female donors when the recipient was male (70% at 3 yr). The results of the multivariate analysis of seven parameters involved in graft survival show that the main parameters significantly controlling graft survival are preimmunization before the graft (p=10−6), HLA‐DR incompatibility (p=0.004), retransplantation (p=0.008), donor sex (p=0.003), and matching for age between donor and recipient (p=0.01). These results suggest that age and sex should be considered as criteria in the choice of donors and recipients in organ allocation.
Increased β2‐microglobulin (B2M) is useful in the detection of post‐transplant lymphoproliferative disease (PTLD)
Authors: Sasaki Truman M. , Pirsch John D. , D'Alessandro Anthony M. , Knechtle Stuart J. , Kalayoglu Munci , Hafez Gholam R. , Sollinger Hans W. 
Published: September 2024

AbstractThis study examines whether changes in β2‐microglobulin (B2M) serum levels are useful in the early detection of post‐transplant lymphoproliferative disease (PTLD). Serum B2M is monitored daily post‐transplant at our center as a marker of change in lymphocyte activation. We identified 16 cases (16/1359; 1.2%) of PTLD from among 1359 kidney and kidney‐pancreas transplants. Those with CNS lymphoma (two patients) and titer change only (one) were not included in this review. Thirteen patients had serum titer and clinical evidence of EBV activity; 12 of these patients had histological evidence of PTLD (lymph node 6, kidney 3, and generalized disease 3). Three patients died with disseminated PTLD infection. Nine are alive but only two have the original transplant kidney. All patients received quadruple immunosuppression for induction, and 11 were subsequently treated with OKT3 or ALG for rejection. The mean number of days of induction ALG therapy was 14.8 d (20 mg/kg/d). The mean number of days of OKT3 therapy for rejection was 14.4 d (5 mg/d). During rejection the highest mean creatinine level was 6.8 mg/dL, and the highest mean B2M level was 16.4. With PTLD, the highest mean creatinine level was 7.0 mg/dL and the highest mean BM level was 32.3 mg/L. The difference in creatinine levels was not significant, but the difference in B2M levels was significant (p<0.01). We conclude that B2M levels are useful markers in differentiating rejection from PTLD.
OKT3 therapy increases cyclosporine blood levels
Authors: Vasquez Eva M. , Pollak Raymond 
Published: September 2024

AbstractNumerous drugs have been reported to alter cyclosporine (CSA) blood levels, most notably, those drugs that interfere with cytochrome P450 metabolism. Our clinical experience suggested that OKT3 therapy may alter CSA blood levels as well. The purpose of this study was to assess the effect of OKT3 therapy on CSA trough blood levels. We reviewed medical records of all CSA‐treated renal transplant recipients during a 3‐yr period to identify patients who received antilymphocyte induction therapy. Patients receiving drugs known to interact with CSA were excluded from analysis. The study population (n=33) was divided into two groups: the OKT3 group consisting of 17 patients who received OKT3 therapy for 7 d post‐transplant (OKT3 group) and the control group consisting of 16 patients who received ALG induction therapy for 7 d post‐transplant (ALG group). Oral CSA (14 mg/kg) was administered preoperatively. Postoperatively, oral CSA (4 mg/kg) was administered twice daily, in addition to corticosteroids. and azathioprine. We evaluated CSA through levels on days 1, 3, 5, and 7 of antilymphocyte therapy and 3 d following completion of antilymphocyte therapy. On days 1 and 3, CSA trough levels did not differ between the two groups. However, median CSA trough levels (HPLC) were significantly higher among OKT3‐treated patients on day 5 of therapy (265 ng/ml), as compared to ALG‐treated patients (136 ng/ml; p<0.0001; Mann‐Whitney U‐test). On days 7 and 10, CSA trough levels did not differ between the two groups. CSA doses, however, had been adjusted based on levels obtained on day 5. We conclude that OKT3 therapy causes a significant rise in CSA trough levels. Recognition of this potential drug interaction is essential in titrating CSA doses in the early post‐transplant period to minimize risks of CSA toxicity or early rejection following induction therapy.
Economic analysis of Neoral in de novo renal transplant patients in Canada
Authors: Kingma I. , Ludwin D. , Dandavino R. , Wolff J.‐L. , Loertscher R. , Beauregard‐Zollinger L. , Bacquet P. , Boucher S. , Rivière M. 
Published: September 2024

AbstractThis pilot economic evaluation was performed as part of the Canadian arm of an international randomized, controlled, double‐blind safety and tolerability trial (OLM‐105 / NOF‐2). The clinical study compared the safety and tolerability of a new microemulsion oral formulation of cyclosporine A (Neoral®) with the oral cyclosporine. A preparation currently in use (Sandimmune SGC®)/(SGC). To assess the economic impact of Neoral in newly grafted renal transplant patients, primary cost data were collected at the five participating Canadian centers and evaluated from the Ministry of Health (MOH) and hospital perspectives. The results of this cost analysis are presented in this paper. Since the new formulation has shown more consistent absorption and a more predictable pharmacokinetic profile, medical resource utilization and, consequently, cost of treatment could be expected to be lower for those renal transplant recipients treated with Neoral than for those receiving standard SGC. The findings of this study support this hypothesis. Robustness of the conclusion was confirmed with sensitivity analyses. Reduced health care costs for patients treated with Neoral were primarily a result of fewer hospitalization days and lower physician costs for inpatient and outpatient procedures.