bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver transplantation: treatment of choice for hepatic and neurological manifestation of Wilson's disease
Authors: Schumacher Guido , Platz Klaus P. , Mueller Andrea R. , Neuhaus Ruth , Steinmüller Thomas , Bechstein Wolf O. , Becker Michael , Luck Werner , Schuelke Markus , Neuhaus Peter 
Published: September 2024

AbstractLiver transplantation (LTX) is an approved method to treat patients with end‐stage liver cirrhosis and acute liver failure due to Wilson's disease. Initially, there was some consideration about the indication for LTX in the case of Wilson's disease with severe neurological impairment but normal liver function. From 1988 until 1995, 13 out of 700 LTX (1.9%) were performed for Wilson's disease. Indications for LTX were (I) intractable neurological impairment with normal liver function (n=4; including one patient with Child A cirrhosis), (II) fulminant hepatic failure (n=3), and (III) end‐stage liver cirrhosis (n=6) (Child B, n=1; Child C, n=5). There were 8 females and 5 males with a mean age of 27 yr (range 15‐34 yr). All patients of group I required continuous nursing care before LTX, in spite of pretreatment with d‐penicillamine and zinc. The most frequent symptoms in these patients were dysphagia (n=4), dysarthria (n=4), tremor (n=4), sialorrhea (n=3), ataxia (n=3), dystonia (n=3) and handwriting difficulties (n=3). All patients of group II presented with hemolytic anemia. The survivalrate was 100%, and all patients were doing well after a mean follow‐up period of 32.8 months (range 8‐68 months). The postoperative course was without severe infectious and other complications. All patients of group I revealed the first signs of improvement for all types of neurological symptoms 4‐6 wk after LTX. One patient has been without any symptoms from 18 months until 5.5 yr after LTX. Two patients with short‐term follow‐up also had noticable improvement of neurological impairment, but residual symptoms are still present. One patient showed only slight improvement. We conclude that Wilson's disease may be a good indication for LTX for both neurological manifestation with stable liver function and hepatic manifestation with cirrhosis or acute liver failure.
Effects of cyclosporin A and FK 506 on lipid metabolism and fibrinogen in kidney transplant recipients
Authors: Hohage H. , Arlt M. , Brückner D. , Dietl K. H. , Zidek W. , Spieker C. 
Published: September 2024

AbstractAfter allogenic transplantations a dramatic increase in the development of arteriosclerotic plaques can be observed, which might be due to metabolic alterations, influenced by changes of the transplant organ or immunosuppression. In this study the effects of FK 506 in kidney transplant patients on cardiovascular risk factors were compared to cyclosporin A (CSA) immunosuppression. Both groups showed no statistical differences in number, kidney function, age, body weight, sex distribution, steroid dosage and follow‐up time after transplantation. Total cholesterol was similar in FK 506‐treated patients (231±22 vs. 278±52 mg/dl) as compared with patients with CsA immunosuppression. Furthermore, there were no differences in triglycerides (220±72 vs. 210±67 mg/dl), HDL‐cholesterol (67±14 vs. 52±18 mg/dl) and fasting glucose (112+36 vs. 116±17 mg/dl). However, the concentration of LDL‐cholesterol (114±21 vs. 167±37 mg/dl), the independent risk factor Lp(a) (11±9 vs. 27±8 mg/dl) and fibrinogen (216±71 vs. 297+47) was lower in FK 506‐treated patients. Our results indicate that FK 506 immunosuppression offers some advantages in cardiovascular risk factors.
Clinical features of acute reversible tacrolimus (FK 506) nephrotoxicity in kidney transplant recipients
Authors: Katari S. R. , Magnone M. , Shapiro R. , Jordan M. , Scantlebury V. , Vivas C. , Gritsch A. , McCauley J. , Starzl T. , Demetris A. J. , Randhawa P. S. 
Published: September 2024

This study was designed to (a) estimate the contribution of tacrolimus nephrotoxicity to episodes of renal allograft dysfunction investigated by needle biopsy, (b) describe the temporal evolution of nephrotoxicity and its response to therapy, and (c) ascertain how often renal dysfunction is associated with concurrent extra‐renal toxicity.Patients were selected based on a rising serum creatinine, normal ultrasound, and biopsy findings leading to a reduction in the dose of tacrolimus and a fall in serum creatinine. Twenty two (17%) cases of nephrotoxicity were identified amongst 128 consecutive kidney transplant biopsies with sufficient clinical data for analysis.There were 13 males and 9 females, 17‐75 yr in age. Tacrolimus was administered initially as a 0.075‐0.1 mg/kg/d IV continuous infusion followed by an oral dose of 0.15 mg/kg twice daily. The onset of nephrotoxicity in this study occurred 1‐156 wk post‐operatively. The mean baseline creatinine was 212.2±168.0 μmol/l (range 88.4‐875.2) and rose 40.6%±14.2% (range 11–66) during episodes of nephrotoxicity (p<0.001). The highest recorded plasma and whole‐blood tacrolimus levels during the toxic episodes were respectively 2.7±0.8 ng/ml (range 1.1‐3.5) and 31.6±10.6 ng/ml (range 14.5‐50.5). The drug levels were considered to be beyond the therapeutic range in 18/22 (82%) patients. The highest tacrolimus level preceeded the rise in serum creatinine in 20 cases by an interval of 1.6±1.8 d. A mean reduction in tacrolimus dosage of 41%±21% (range 11–89) led to a 86% ± 18% (range 45–100) fall in the serum creatinine within 1‐14 d (p<0.001). Interactions between tacrolimus and clarithromycin, diltiazem, or itraconazole modified the pharmakokinetic parameters in three cases. Serum potassium >5.0 mequiv./1 was recorded in 9/22 (41%) cases. Three or more elevations in blood glucose >7.7 mmol/l (140 mg/dl) were recorded in 4/11 (36%) non‐diabetic patients. Hand tremors were seen in two (9%) cases and elevated diastolic blood pressure > 90 mmHg in seven (32%) patients.In conclusion, tacrolimus nephrotoxicity accounted for 17% of graft dysfunction episodes investigated by biopsy. Concurrent hyperglycemia, hyperkalemia, or tremors were noted in several patients. Nephrotoxicity responded well to reduction in the drug dosage.
Risk factors for prolonged hospitalization after kidney transplants
Authors: Matas Arthur J. , Gillingham Kristen J. , Elick Barbara A. , Dunn David L. , Gruessner Rainer W. G. , Payne William D. , Sutherland David E. R. , Najarian John S. 
Published: September 2024

AbstractA major variable in the cost of kidney transplants is the length of initial hospitalization. Using multivariate analysis, we studied risk factors for hospital stay > 10 d post‐transplant. Between 1 January 1985 and 31 August 1995 a total of 1588 patients underwent first or second kidney transplants at the University of Minnesota. Antibody was used for 1 wk in cadaver donor recipients and for 2 wk in pediatric recipients (resulting in a long stay for all pediatric recipients). Adult living related donor recipients were immunosuppressed with triple therapy.Donor risk factors studied were age (<15, 15‐50, > 50 yr) and, for cadaver recipients, preservation time (< 12, 12‐18, 18‐24, 24‐30, >30 h) and cause of death (trauma, cerebrovascular accident, or cardiac). Recipient risk factors studied were age (< 18, 18‐55, > 55 yr); sex; transplant number; antigen mismatch; peak PRA; PRA at transplant (< 11, 11‐50, >50); diabetic status; pretransplant dialysis (vs. pre‐emptive transplant); pretransplant cardiac, peripheral vascular, or respiratory disease; and delayed graft function (DGF) (dialysis in the first week vs. no dialysis). Risk factors were analyzed separately for living donor and cadaver donor recipients. For cadaver donor recipients, DGF was the major risk factor (p < 0.0001); others were age 55 yr (p=0.03) and diabetes (p=0.02). For living donor recipients, DGF was also a risk factor (p=0.003); others were diabetes (p=0.01), retransplant (p=0.006), PRA at transplant > 50 (p < 0.0001), age > 55 yr (p=0.02), pretransplant respiratory disease (p=0.005), and pretransplant dialysis (p=0.005).Because DGF was the major risk factor for a prolonged stay, we then studied risk factors for DGF using multivariate analysis. For cadaver donor recipients, risk factors were recipient weight > 90 kg (p=0.004), preservation time 24 h (p=0.03), PRA at transplant > 50 (p=0.03), and donor age < 15 or > 50 yr (p=0.002). For living donor recipients, risk factors were recipient age 18 yr (p=0.01), donor age > 50 yr (p=0.03), female sex (p=0.05), pretransplant respiratory disease (p=0.1), pretransplant peripheral vascular disease (p=0.05), and recipient weight > 90 kg (p=0.1).From our data, a profile emerged of recipients likely to have a longer hospital stay. Important variables, either simultaneous with or related to DGF, include donor and recipient age, diabetes, pretransplant recipient weight, PRA at transplant, preservation time, and pretransplant respiratory or peripheral vascular disease.
Diagnosing cytomegalovirus disease in CMV seropositive renal allograft recipients: a comparison between the detection of CMV DNAemia by polymerase chain reaction and antigenemia by CMV pp65 assay
Authors: Lo C. Y. , Ho K. N. , Yuen K. Y. , Lui S. L. , Li F. K. , Chan T. M. , Lo W. K. , Cheng I. K. P. 
Published: September 2024

AbstractThe optimal diagnostic test for CMV disease in renal allograft recipients in a locality with a high CMV seropositive rate has not been fully determined. We compared the usefulness of the CMV pp65 antigenemia (CMVAg) assay with the detection of DNAemia by a nested polymerase chain reaction (PCR) method in diagnosing CMV disease in 56 renal allograft recipients, of whom 50 (89.2%) were CMV seropositive prior to transplant (tx). Positive CMV‐Ag assays were found in 126/281 samples (44.8%) of 27 patients (48.2%) of whom five had seven episodes of CMV disease. The remaining 22 patients were asymptomatic. The symptomatic patients had significantly higher median peak CMV‐Ag levels than the asymptomatic patients [800 (160–1380) vs. 5 (1–604) per 2 × 105 peripheral blood leukocyte (PBL), p<0.0001]. One hundred and eight samples were tested by both CMV‐Ag and PCR methods. Out of the 108 samples, 89 showed concordant results (37 positive and 52 negative for both tests). Seventeen samples of 11 patients were CMV‐Ag negative / PCR positive. Out of these 11 patients, two had CMV disease and the discrepancy in the results was due to blood samples taken after the start of ganciclovir therapy. Falsely negative PCR tests were found in two samples of two patients with positive CMV‐Ag assays. With a cutoff antigenemia level of 100 per 2 × 105 PBL, the sensitivity, specificity, positive and negative predictive values for diagnosing CMV disease were 100, 96, 71.4 and 100%, respectively. On the other hand, CMV DNAemia was detected in many asymptomatic patients, and the PCR test results correlated poorly with the clinical manifestations of the disease. In symptomatic patients undergoing ganciclovir therapy, the quantification of antigenemia level allowed the assessment of treatment efficacy. In addition, positive CMV‐Ag assays at the end of therapy were associated with the subsequent relapse of CMV disease in two patients. The high specificity, together with the short processing time of 4 h, make the CMV‐Ag assay the test‐of‐choice for diagnosing CMV disease in a renal transplant population with a predominance of CMV seropositive patients.
Treatment of steroid‐resistant and recurrent acute cardiac transplant rejection with a short course of antibody therapy*
Authors: Cantarovich Marcelo , Latter David A. , Loertscher Rolf 
Published: September 2024

AbstractThe purpose of this study was to assess the efficacy of short courses of OKT3 and ATG, respectively, for steroid resistant or recurrent acute allograft cardiac rejection (AR). Between June 1988 and March 1994, 101 heart transplant patients were treated with a quadruple sequential immunosuppression protocol (ATG, azathioprine, CSA, and prednisone). AR was diagnosed by endomyocardial biopsy (EMB), and patients with scores. >2 (ISHLT) received pulse methylprednisolone, 500 mg i.v. on 3 consecutive days. In cases of steroid‐resistant or recurrent AR, OKT3 (5 mg/d) or ATG (1.5‐2.5 mg/kg/d), was administered for 5‐7 d instead of the usual 10‐14 d course. OKT3 (17 courses; 10 steroid resistant, 7 recurrent AR; 5.3±0.7 doses) was given to 16 patients (4F/12M, 45±11 yr), 29‐269 d after transplantation. ATG (8 courses; 5 steroid resistant, 3 recurrent AR; 4.9±0.6 doses) was given to 8 patients (1F/7M, 53±7 yr), 23‐503 d after transplantation. Successful treatment of AR with a score <2 at the first and second EMB after treatment was 88% and 88% with OKT3, and 87.5% and 100% with ATG, respectively. Throughout follow‐up (50+22 months after OKT3; 49+28 months after ATG), there was a trend towards lower incidence of subsequent AR after ATG (25% vs. 69%, P=0.09), and similar incidence of infections, graft atherosclerosis and mortality. No cases of lymphoproliferative disorder were observed. We conclude that short courses of OKT3 or ATG are safe and effective for the treatment of steroid resistant or recurrent AR, with a similar incidence of complications. These results may have cost‐effectiveness implications and need to be confirmed in a randomized study.
Leuconostoc bacteremia after liver transplantation: another cause of vancomycin resistant gram‐positive infection
Authors: Espinoza Ricardo , Kusne Shimon , Pasculle A. William , Wada Suzanne , Fung John , Rakela Jorge 
Published: September 2024

AbstractLeuconostoc sp. are gram‐positive bacteria intrinsically resistant to vancomycin, which can be confused with streptococci based on routine microbiological characteristics. Infections secondary to Leuconostoc are uncommon, and usually affect patients with underlying diseases, prior use of vancomycin and those with central lines. The most common clinical presentation is fever secondary to a central line infection. We report the first case of Leuconostoc infection in a solid organ transplant recipient. The patient developed Leuconostoc bacteremia secondary to peritonitis, 60 d after undergoing liver transplantation. He was treated with clindamycin, gentamicin and underwent surgical debridement, but succumbed to other complications.
Combined kidney‐pancreas and parathyroid transplantation: a case report
Authors: Rahusen Frans , Munda Rino , Hariharan Sundaram , First M. Roy , Demmy Ann 
Published: September 2024

AbstractWe report the first successful multiorgan kidney‐pancreas and parathyroid tissue transplant in a patient with autoimmune polyglandular syndrome and medullary cystic disease. Successful transplantation included. quadruple drug induction therapy consisting of antithymocyte globulin, azathioprine, cyclosporine and prednisone. All three grafts are functioning 2 yr after transplantation.
Grandparent donors in a living related renal transplant program
Authors: Nyberg Scott L. , Manivel J. Carlos , Cook Marie E. , Gillingham Kristen J. , Matas Arthur J. , Najarian John S. 
Published: September 2024

AbstractClinical renal transplantation is limited by the number of cadaver and living related donors. The use of kidneys from older donors and nonfirst‐degree relatives, including grandparents, has increased the supply of organs for transplantation. The purpose of this study was to assess donor and recipient outcomes after living related renal transplants between grandparent donors and grandchild recipients. Fifteen living related renal transplants using grandparent donors were performed at the University of Minnesota from 1971 to 1995. All medical records from donors and recipients were retrospectively reviewed. In addition, all grandparents or, in one case, a surviving family member were contacted to obtain current information on medical health and feedback about the donation process. A current serum creatinine (Cr) level was obtained from 14 donors and 15 recipients. Statistical calculations were performed using the SAS system. Eleven grandmothers and four grandfathers, 34‐70 yr old (mean, 55 yr) at the time of transplantation, donated a kidney to 15 grandchildren with end‐stage renal disease. There were no major surgical complications in either group. One donor died from unrelated causes; the other 14 donors are alive with stable renal function (1.3±0.3 mg/dL). Of 15 transplanted kidneys, 10 remain functional (Cr 1.3±0.7 mg/dL) with 2‐ and 5‐yr graft survival rates of 76% and 63%, respectively. Our results indicate that healthy grandparents provide an excellent population for living related kidney donation.
Influence of steroid withdrawal on proteinuria in renal allograft recipients
Authors: Ghandour Fadi Z. , Knauss Thomas C. , Mulligan David C. , Schulak James A. , Hricik Donald E. 
Published: September 2024

AbstractThe ratio of urine protein/urine creatinine in spot urine specimens was measured to determine the influence of steroid withdrawal and other clinical variables on urinary protein excretion in 135 primary renal transplant recipients, including 73 patients in whom steroid withdrawal was never attempted and 62 patients in whom steroid withdrawal was attempted at various times following transplantation. Both univariate and multivariate analyses showed that steroid withdrawal per se did not directly influence proteinuria. However, patients who renewed steroid therapy because of acute allograft rejection following attempted steroid withdrawal exhibited significantly more proteinuria than was encountered either in patients who remained steroid‐free or in those for whom steroid withdrawal was never attempted. This study suggests that steroid withdrawal itself does not lead to proteinuria, however, acute rejection following steroid withdrawal clearly accelerates urinary protein excretion that may be the harbinger of chronic allograft rejection.
Efficacy and side‐effects of cyclosporine dose monitoring with levels 6 h after the morning dose in heart transplant patients*
Authors: Cantarovich Marcelo , Besner Jean‐Guy , Fitchett David H. , Latter David A. 
Published: September 2024

AbstractThe purpose of this study was to compare CsA dose monitoring with trough levels (T0) vs. levels obtained 6 h after the morning dose of CsA (T6), with respect to the incidence of acute rejection and renal dysfunction, and the cumulative dose, as well as the cost of CsA after heart transplantation. Twenty consecutive adult heart transplant patients receiving quadruple sequential immunosuppression were prospectively randomized into CsA monitoring with T0 (Group I) vs. T6 levels (Group II). Oral CsA was started at a dosage of 2 mg/kg/d, 1‐4 d after transplantation. The target range for either T0 or T6 was 150 to 250 ng/ml (enzyme multplied immunologic technique), respectively. The CsA dose was increased or decreased by 0.5–1 mg/kg/d if the measured level was outside of the target range. Throughout the follow‐up period (Group I, 11±2 months; Group II. 10±3 months), the incidence of acute rejection (ISHLT grade ≥ 2) was 50% in each group. The left ventricular ejection fraction and serum creatinine were similar in both groups at 1 month and at the end of the follow‐up. The maximal dose of CsA (mg/kg/d): 3.8±1 vs. 5±0.6 (P=0.002), the minimal dose: 2.2±0.7 vs. 3.4±0.8 (P=0.003), and the current dose: 2.6±0.6 vs. 3.5±1 (P=0.02), were lower in Group II, as well as the cumulative dose of CsA (mg): 61790±19754 vs. 88524±18082 (P=0.005), and its cost (CDN$): 3589±1116 vs. 5 106±1045 (P=0.005). In conclusion, CsA dose monitoring with T6 was associated with a 30% lower CsA dose and cost compared to T0, with the same effectiveness in the prevention of acute rejection, and similar cardiac and renal function.
Role of endomyocardial biopsy in the diagnosis of chronic rejection in human heart transplantation
Authors: Mindán F. J. Pardo , Panizo A. , Lozano M. D. , Herreros J. , Mejía S. 
Published: September 2024

AbstractTo assess the pathologic findings observed in the setting of posttransplant graft atherosclerosis, we have studied 18 endomyocardial biopsies (EMB) from 18 heart‐transplanted patients collected at the same time that a coronary angiography (CA) showed changes consistent with graft atherosclerosis. Twenty‐two EMB from patients with heart transplant with normal CA were used as controls. In spite of the small size of the sample, the number of acute rejection (AR) episodes correlated with the appearance of graft atherosclerosis (p<0.001). Heart biopsies in graft atherosclerosis showed myointimal proliferation, thickening and folding of the wall of precapillary arteries, myocyte hypertrophy, and interstitial and perivascular fibrosis. Type III and type IV collagen, laminin, and fibronectin were increased in areas of interstitial and perivascular fibrosis, as well as in the vessel's wall. Fibronectin accumulation was more evident in the subendothelium and inner media of affected vessels. These changes were never found all together in control biopsies. Even though the inespecificity of some of those findings, we conclude that chronic graft atherosclerosis in a heart transplant may be suspected by endomyocardial biopsy when most of these alterations are seen together, especially if small precapillary arteries are present in the specimen.
Orthotopic liver transplantation for adult‐onset Type II citrullinaemia
Authors: Kawamoto Shunji , Strong Russell W. , Kerlin Paul , Lynch Stephen V. , Steadman Charles , Kobayashi Keiko , Nakagawa Shiro , Matsunami Hidetoshi , Akatsu Takuhiko , Saheki Takeyori 
Published: September 2024

AbstractCitrullinaemia is a rare autosomal recessive disorder due to a deficiency of argininosuccinate synthetase (ASS). While the clinical course of the adult onset form (Type II) is unpredictable, many patients undergo sudden deterioration with progressive cerebral oedema. Two patients with Type II citrullinaemia were referred for liver transplantation. One patient was successfully transplanted, and his plasma citrulline level decreased from 300 to 69 μmol/l (normal range 20‐60 μmol/l); Fisher's ratio increased to a normal range within 24 h of transplantation. The other patient died from cerebral oedema, despite optimal pharmacological measures, while awaiting a suitable donor organ. Dietary and pharmacological treatment is vital before liver transplantation. The level of serum arginine requires regulation, as it can rise secondary to citrullinaemia in Type II disease. An immunocytochemical study of the liver in both patients showed a clustered distribution of ASS which is associated with a dismal prognosis compared with patients who have a homogenous distribution. Distribution of ASS was normal in the transplanted liver.Liver transplantation is effective therapy for adult‐onset Type II citrullinaemia. A clustered pattern of ASS distribution in a liver biopsy is a significant feature to activate early referral for liver transplantation.
Iliac reconstruction with arterial allograft during pancreas–kidney transplantation
Authors: Benedetti Enrico , Baraniewski Henry M. , Asolati Massimo , Pollak Raymond , Schuler James J. 
Published: September 2024

AbstractAn intraoperative dissection of the external iliac artery during pancreas transplantation was successfully repaired using the donor iliac artery allograft as a conduit between the internal iliac and distal external iliac artery. An angiogram performed 6 months after surgery showed a patent bypass without stricture or pseudoaneurysm. At 1 yr follow‐up after transplant the grafts are functioning well, and the affected extremity is normal. In immunosuppressed recipients of solid organ transplants, fresh arterial allografts may be successfully used for iliac artery reconstruction. Further study will be needed to determine the role of arterial allografts for lower extremity bypass surgery in immunosuppressed patients.