bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pancreatic pseudocyst formation following renal transplantation: A lethal development
Authors: Chapman William C. , Nylander William A. , Williams Lester F. , Richie Robert E. 
Published: September 2024

In this retrospective study, extending from 1 January 1972 to 30 June 1988, we identified 10 patients who had pancreatitis and who developed pancreatic pseudocysts out of 1177 patients receiving renal transplants. Two patients had complete spontaneous resolution of their pseudocysts over 25 and 30 days of observation, while the remainder required operative intervention. Standard internal drainage was possible in only 1 of the 8 operated patients. This patient was followed with serial CT scans for more than 100 d prior to exploration. The remaining 7 patients had either thin cyst walls (N = 3) or infected cysts (N = 4) at operation (mean period of preoperative observation 36.5 d for thin‐walled cysts, 39 d for infected cysts) and therefore received external drainage. There were seven major complications in these 10 patients: 2 patients developed massive intraabdominal bleeding from splenic artery erosions, 1 had spontaneous rupture of a pancreatic pseudocyst, 1 patient developed a colocutaneous fistula, and 3 lost graft function. Overall mortality was 50%. Severe pancreatitis, sepsis, and multiple organ failure was the cause of death in 4 out of 5 deaths. Transplant recipients who develop pancreatitis and pancreatic pseudocysts should be managed with reduction of immunosuppressive therapy to maintenance levels, close observation for signs of sepsis and immediate aggressive management once this is present. In the stable patient, elective internal cyst drainage may not be possible until later than in the non‐immunosuppressed patient. This study represents the largest reported series of patients with pancreatic pseudocysts following renal transplantation and confirms the ominous nature of this complication in renal transplant recipients.
Concomitant reduction in urinary amylase and acute first‐phase insulin release predict pancreatic allograft transplant rejection in type I diabetic recipients
Authors: Henry Mitchell L. , Osei Kwame , O'Dorisio Thomas M. , Tesi Raymond J. , Ferguson Ronald M. 
Published: September 2024

Decreased urinary amylase (UA) concentration has been advocated as an early marker for pancreatic allograft rejection in type I diabetic recipients. Since there is a dissociation between exocrine and endocrine pancreatic functions, we speculated that a specific beta cell marker is necessary to confirm the specificity and sensitivity of decreased UA as a marker for endocrine function. Because blunted acute first‐phase insulin release is regarded as an important predictor for future beta cell destruction, we evaluated the phases of insulin secretion to intravenous (i.v.) glucose (25 g) and glucagon (1 mg) in 9 type I diabetic pancreatic allograft recipients who had diagnosis of presumed pancreatic graft rejection based on UA alone. All the patients were normoglycemic and insulin‐independent at the time of the study. Despite remarkable depression (≥ 50–90%) in UA values in the subjects and normoglycemia, 5 patients had qualitatively and quantitatively normal acute first‐phase insulin release (Group 1) while the remaining 3 had blunted first‐phase insulin release (Group 2). While all the Group 1 patients have maintained normoglycemia and insulin‐independence for 6–44 months (average 18 months), Group 2 patients suffered pancreatic graft failure (2 rejection, 1 thrombosis). Our preliminary data demonstrated that progressive decline in UA alone does not necessarily reflect pancreatic endocrine failure. In contrast, blunted acute first‐phase insulin release in the face of decreased UA appears to be a harbinger of pancreatic graft failure.
Pancreas transplantation: long‐term results
Authors: Caldara Rossana , Sanseverino Roberto , Lefrancois Nicole , Martin Xavier , Martinenghi Sabina , Dubernard Jean Michel 
Published: September 2024

The rationale behind pancreatic transplantation is to provide a self‐regulated, endogenous source of insulin and other islet hormones, thus restoring normal metabolism with the ultimate goals of prevention, stabilization or reversal of secondary degenerative complications. We report clinical and metabolic data of 8 patients submitted to simultaneous kidney and pancreas transplantation in our institute, who had a pancreatic graft function for 4 (1 case) and 5 (7 cases) years. To assess the impact of transplanted pancreatic mass on long‐term function, we also included 10 patients from a comparative study between segmental pancreas transplantation (group A, 5 pts) and whole pancreas with enteric diversion transplantation (group B, 5 pts), who had pancreatic function for 2 and 3 yr. All patients are alive. Seven of these patients are off insulin, while one patient lost pancreatic function during an operation performed to correct an arterial stenosis of the graft. HbA1c levels were normal during the entire follow‐up period (5.2 ± 0.14% at 4 yr; 5.1 ± 0.6% at 5 yr). In 24‐hour metabolic profiles we observed near normal blood glucose levels, with good insulin release at 4 yr and a mild hyperglycemia at 5 yr (BG at 9 p.m.: 8.8 ± 1.3 mmol/l). OGTT performed in 5 patients, 4 yr after pancreas transplantation, showed an impaired glucose tolerance, while the same test performed at 5 yr, showed higher values (BG 120 minutes: 14.7 ± 0.2 mmol/l). Group A and group B patients are all alive, with good renal and pancreatic function. The same values of fasting blood glucose and HbA1c were observed at 2 and 3 yr, but an impaired glucose tolerance was observed in group A recipients during OGTT performed at the same time‐interval. Nerve conduction velocity improved in the post‐transplant period, but whether the improvement is due to treatment of uremia or to the normalization of glucose metabolism is difficult to determine. In the long term, we observed a stabilization of advanced retinopathy, present at the time of transplantation in most of our patients.
Cyclosporin A does not cause hyperlipidemia in kidney graft recipients
Authors: Traindl O. , Reading S. , Franz M. , Pohanka E. , Pidlich J. , Kovarik J. 
Published: September 2024

The aim of this study was to compare total cholesterol and triglyceride levels in 281 kidney graft recipients with stable graft function and different immunosuppressive regimens. All patients had low‐dose prednisolone (mean daily dose 7.7 mg ± 4.8). In 57 patients immunosuppression consisted of prednisolone and azathioprine (Group A), 141 had prednisolone and cyclosporin A (Group B) and 83 were treated with prednisolone, azathioprine and cyclosporin A (Group C). There was no significant difference in daily prednisolone dose, sex, age, mean graft survival and proteinuria between the three groups. Cholesterol values for Groups A, B and C were 257 mg/dl, ± 69.6, 261 mg/dl, ± 70.2 and 247 mg/dl, ± 65.9, respectively. The triglyceride values for the groups A, B and C were 201 mg/dl, ± 199, 211 mg/dl, ± 139, and 220 mg/dl, ± 154. All values are the group means with their standard deviations. Comparison of the cholesterol and triglyceride values between the three treatment groups showed no significant differences. Importantly, no difference could be observed between patients receiving cyclosporin A and conventional therapy. We conclude that immunosuppression with cyclosporin A need not cause hyperlipidemia in the face of low‐dose prednisolone administration.
Successful pancreas and renal transplantations from a donor who died of cyanide poisoning
Authors: Hantson P. , Squifflet J. P. , Vekemans M. C. , Evrard P. , Hassoun A. , Sepulchre M. A. , De Ceuninck P. , Mahieu P. 
Published: September 2024

We report successful pancreas and renal transplantations from a brain‐dead victim of cyanide poisoning. A 41‐year‐old diabetic man with pre‐end‐stage renal failure received the pancreas and the right kidney. The left kidney was implanted in a 27‐yr‐old woman with chronic renal failure. Postoperative evolution was not complicated. At 6 months, grafts function remains excellent. The management of cyanide poisoning, especially in the setting of organ donation, is discussed.
Successful repair of a transplant renal artery mycotic pseudoaneurysm
Authors: Sánchez Luis A. , Schechner Richard , Greenstein Stuart M. , Tellis Vivian A. 
Published: September 2024

Abstract:Mycotic arterial aneurysms and pseudoaneurysms are uncommon vascular complications of renal transplantation. These vascular infections usually present with severe hemorrhage, and are often associated with high morbidity and mortality. The traditional treatment for these aneurysms has been debridement and ligation of the affected artery, with resulting loss of the renal allograft in most cases. We present a case of a pseudoaneurysm in a transplant renal artery following a Candida albicans infection. The pseudoaneurysm was diagnosed prior to rupture and was successfully treated by repairing the arterial defect using a greater saphenous vein patch, with preservation of the renal allograft. A review of the literature is included.
Myocardial preservation in brain‐dead patients maintained with vasopressin and catecholamine
Authors: Okamoto Ken , Kinoshita Yoshihro , Yoshioka Toshlharu , Kawaguchi Naomasa , Onishi Shunzo , Sugimoto Tsuyoshi 
Published: September 2024

Abstract:In order to examine hemodynamic and ultrastructural changes of the myocardium, 37 brain‐dead patients were divided into three groups by circulatory support: (1) epinephrine alone (group A, n= 12), (2) arginine vasopressin (ADH) and epinephrine (group B, n= 12), (3) ADH and dopamine (group C, n= 13). In group A, a large dose of epinephrine failed to improve initial circulatory instability and to prevent hemodynamic deterioration and eventual cardiac arrest occurring within 3 days. In contrast, the systemic circulation in groups B and C was rapidly improved, and a small dose of epinephrine or dopamine could steadily maintain normal hemodynamics until the ventilator was disconnected in 21 of 25 patients. The mean duration of initial circulatory instability in group B was significantly shorter than that in group C. Myocardial ultrastructure of biopsy specimen was semiquantitativcly analyzed in all the groups. In group A, swollen mitochondria and nuclei, intracellular edema and dilated sarcoplasmic reticulum were marked soon after brain death. Irreversible changes such as disrupted mitochondria, pyknosis of nucleus and contraction bands of myofibrils were noted by the 3rd day. In groups B and C, the myocardial changes were mild and irreversible changes in organelles were rare throughout this study. Especially, the myocardial ultrastructure in group B was almost normal for 2 weeks. The degree of ultrastructural changes was related to the duration of circulatory instability, which suggested that the major impairment of the heart might result from instability of systemic circulation after brain death. Evidence from this study suggested that our method with the combined administration of ADH and epinephrine might be beneficial for procurement of suitable heart donors.
A case control study of renal transplantation in patients with type I diabetes
Authors: Munson* Jennifer L. , Bennett William M. , Barry John M. , Norman Douglas J. 
Published: September 2024

Abstract:A case control study was undertaken comparing the outcome of 208 renal allografts transplanted into diabetic recipients with those transplanted into an appropriately matched group of non‐diabetic recipients. In each group there were 151 cadaver, 21 two‐haplotype identical, 35 one‐haplotype identical, and one zero‐haplotype identical living‐related grafts. For the entire group of diabetics, 1‐ and 5‐year graft survivals were 71.3% and 46%. Graft survivals for the non‐diabetic recipients at 1 and 5 yr were 81.8% and 57.8% (p<0.05). In all patient subgroups divided according to the donor source, the graft and patient survival rates for the non‐diabetic recipients exceeded those of the diabetic recipients. One‐ and 5‐yr diabetic patient survivals were 90% and 70%, and for the non‐diabetics they were 97% and 95%, respectively (p< 0.001). There were 40 deaths among the diabetics and 15 among the non‐diabetics. Cardiovascular disease was the major cause of death in the diabetics, accounting for 40% of the deaths. In addition, allograft loss due to patient death was a significant cause of graft loss in the diabetic group, 24 grafts (28%). Seven grafts (10%) were lost due to patient death in the non‐diabetic group (p<0.05). Post‐transplant, diabetic recipients had a greater incidence of stroke, angina, myocardial infarction, peripheral vascular disease, urinary tract infections (p<0.01 for each), and wound infections (p<0.05). Despite improvements in results with renal transplantation in diabetics, our study indicates that the results do not approach those of an appropriately matched group of non‐diabetics. With their higher incidence of complications, the management of diabetics will continue to be a challenge.
Early aggressive management for the prevention of renal allograft loss and patient mortality following major urologic complications
Authors: Waltzer W. C. , Frischer Z. , Shabtai M. , Jao S. , Rapaport F. T. 
Published: September 2024

Abstract:In 219 renal allograft transplants performed at the University Hospital, State University of New York at Stony Brook, 24 urological complications were encountered (10.8%). There were 12 episodes of ureteral obstruction and 8 of ureteral fistulas with extravasation. Four patients had bladder fistulas. In all patients, early surgical corrective procedures were employed. No graft or patient losses occurred as a result of these complications or of their treatment (0% mortality; 0% graft loss). Based on this as well as others' experience (1–24), it appears that early aggressive diagnosis and surgical treatment, combined with urological expertise, are a central requirement for the avoidance of graft loss or mortality following urological complications.
Acute focal bacterial nephritis in a kidney transplant
Authors: Levy David A. , Seftel Allen , Schulak James A. 
Published: September 2024

Abstract:Acute urinary tract infections and graft pyelonephritis are common complications in kidney transplantation. We report a case of a complex renal allograft infection that developed into acute focal bacterial nephritis (lobar nephroma). The diagnosis was made by both ultrasound and computed tomographic imaging and final bacterial isolation required needle aspiration and biopsy. The patient, who developed severe renal dysfunction as a result of this infection, recovered after appropriate antibiotic therapy. Follow‐up sonographic examination revealed a residual area of scarring and her renal function has stabilized but has not returned to her pre‐infection baseline. This case illustrates the importance of radiologic imaging and tissue biopsy in order to make the diagnosis and to render appropriate therapy for acute focal bacterial nephritis in a kidney transplant.
Management of the multiple organ donor
Authors: Fisher Robert A. , Alexander J. Wesley 
Published: September 2024

Abstract:The identification and management of the brain‐dead multiple organ donor should be treated as a critical care subspeciality of medicine because of the life‐saving value of organ donation to transplant recipients. The growing mortality rate amongst persons awaiting a transplant will negate future advances in allograft survival if donor organ availability does not improve. In this review we outline the problems and present solutions in the areas of donor recognition; medical, legal and legislative issues of brain death; and the request and referral for donation. The scientific and practical strategies of the transition from brain injury‐oriented care to donor organ maintenance are reviewed in depth.
Posterior subcapsular cataract after kidney transplantation
Authors: Virga G. , Maresca M. C. , Calconi G. , Gatti P. L. , Rosa C. Dalla , Falco G. Di , Chlara G. , Valtorta F. , Boschi G. , Vianello A. 
Published: September 2024

79 kidney transplanted patients whose grafts functioned for at least 1 year (mean follow‐up 44.4, range 14‐153 months) were examined for posterior subcapsular cataract (PSC) after kidney transplantation in a search for factors able to predict the development of this disease. PSC developed in 36 patients, was symptomatic in about half of them and required lens removal in 4 cases. There were no differences in the prevalence of the disease with regard to the immunosuppressive treatments (steroids + azathioprine; steroids + CsA; steroids + CsA + azathioprine) or pre‐transplant steroid therapy. We found that total amounts of steroids, azathioprine and CsA in the 1st yr after transplantation, number of steroid boli in the 1st yr after transplantation, age, dialytic age, and renal function at the end of the 1st yr after transplantation were not explanatory factors for PSC. An individual susceptibility linked to some HLA‐A, B antigens was not identified. A protective role against steroid‐induced PSC for low doses of aspirin was not demonstrated. PSC after kidney transplantation remains a puzzling problem.
An evaluation of the cyclosporine parent‐compound‐specific whole blood TDx assay
Authors: Pescovitz Mark D. , Book Benita K. , Pollard Stephen G. , Milgrom Martin L. , Leapman Stephen B. , Filo Ronald S. 
Published: September 2024

The new Abbott TDx cyclosporine parent‐compound‐specific fluorescence polarization immunoassay (TDxP) was evaluated and compared to the cyclosporine‐and‐metabolites‐specific TDx (TDxT) and a cyclosporine parent‐compound‐specific radioimmunoassay (RIA) (Sandimmun‐Kit, INCSTAR). The TDxP assay was linear within the range of 31 to 1600 ng/ml (r = 0.985) with a lower limit of detection of < 31 ng/ml. The TDxP had excellent intra‐ and interassay reproducibility (CV = 1.2 to 4.5) that was significantly better than that of the radioimmunoassay. 230 whole blood samples obtained from 65 kidney, 19 liver, and 8 pancreas transplant recipients were analyzed with each of the three assay methods. TDxP had a much stronger correlation with the RIA than did TDxT (r = 0.95 versus 0.83). The difference between the correlations was greatest for the liver and pancreas recipients. The mean ratio of the cyclosporine level determined by TDxP to RIA was 1.0 versus 2.4 for TDxT to RIA. The new TDxP assay provides results equal to a parent‐compound‐specific RIA but with the added advantages of decreased sample turn‐around time and improved intra‐ and interassay coefficients of variation.
Mycobacterial infection after liver transplantation: A report of three cases and review of the literature
Authors: Sterneck Martina , Ferrell Linda , Ascher Nancy , Roberts John , Lake John 
Published: September 2024

We report 3 cases of tuberculosis occurring after liver transplantation. Two patients presented with fever, 2 and 8 months after transplantation, while the 3rd patient was asymptomatic. In the 1st case, disseminated disease developed rapidly; the other 2 patients presented with pulmonary disease only. In all patients the mycobacterial infection was treated with INH, rifampin and pyrazinamide, as well as ethambutol in the 1st case. Anti‐tuberculous treatment was complicated in the 1st case by development of severe INH hepatitis after 9 months, necessitating drug withdrawal. The prophylaxis, diagnosis and treatment of mycobacterial infections in liver transplant recipients are discussed.
Predictive value of doppler ultrasonography in renal transplantation
Authors: Germain Michael J. , Lipkowitz George S. , Patel Jehangir , Hampf Frederick 
Published: September 2024

During a 17‐month period, 268 doppler sonography studies were performed on 46 consecutive renal transplant patients. There were 35 episodes of acute rejection in 10 patients, 8 episodes of delayed function and 47 episodes of high cyclosporine levels (greater than 800 ng/dl by TDX method) in 21 patients. Defining an abnormal resistive index (RI) as greater than 0.8 or a 20% increase above baseline, the test has a specificity of 99% and a sensitivity of 94% in the 1st month post‐transplant and had an overall predictive value of 99%. Episodes of high cyclosporine levels ranging from 800 to 1650 ng/dl did not correlate with a high RI except in one circumstance with concurrent acute rejection. Within the 1st month post‐transplant, only 1 false‐negative study occurred. An additional 8 false‐negative studies occurred beyond 1 month post‐transplant. Patients with delayed function are separated into three groups based on the doppler ultrasounds: Group I, patients with an accelerated acute rejection with high RI (N = 2); Group II, patients with true ischemic acute tubular necrosis with normal RI (N = 2); and Group III, patients with possible immunologically‐mediated delayed function with intermediate RI between 0.6 and 0.8 (N = 4). Doppler ultrasound is a useful ancillary test to confirm the clinical suspicion of acute rejection. Since high cyclosporine levels do not cause an increase in RI, doppler ultrasound may help to avoid confusion between acute rejection and cyclosporine toxicity. Additionally, this test may offer insight into the cause of early post‐transplant renal dysfunction.
CD3+ and CD19+ lymphocyte depletion following a course of anti‐lymphocyte globulin in renal allograft recipients
Authors: Mordacchini M. , Calconi G. , Falco G. Di , Innocenti P. , Maresca M. C. , Mastrosimone S. , Mercatante M. R. , Nieri A. 
Published: September 2024

The T‐cell and B‐cell monitoring in peripheral blood of 13 renal allograft recipients, who received a prophylactic course of anti‐lymphocyte globulin (ALG) in the early post‐transplant period, showed a selective effect of ALG on CD3+ cells. The adjustment of ALG dosages, in order to maintain the CD3+ cell number below 10 cells/mm3 (analogously to OKT3 treatment) has provided a rejection‐free course of 3 months in all but one the patients of the study, without increasing the risk of ALG immunosuppression.
Optimizing the immediate posttransplant prednisone dose – A prospective randomized trial
Authors: Matas A. J. , Payne W. D. , Gillingham K. J. , Dunn D. L. , Sutherland D. E. R. , Najarian J. S. 
Published: September 2024

Adult recipients of HLA non‐identical living‐related donor (LRD) kidneys were stratified into low‐risk and high‐risk groups and randomized to receive high‐dose (starting at 1 mg/kg) vs. low‐dose (starting at 30 mg/day) prednisone. Patient and graft survival and 1‐year creatinine levels for the two groups were identical. The low‐dose group had more rejections; only 38% of low‐dose patients were rejection‐free vs. 65% of high‐dose patients (p < 0.05). In part, because of the increased incidence of rejection, the low‐dose group had significantly more readmissions (p = 0.04). We conclude that, in LRD transplant recipients, low‐dose and high‐dose prednisone protocols are associated with equivalent graft and patient survival. However, there is an increased incidence of rejection and readmissions with low‐dose prednisone.