bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of resistant hypertension following renal transplantation with an angiotensin‐converting‐enzyme inhibitor
Authors: Schindler J. M. , Keusch G. , Binswanger U. 
Published: September 2024

The antihypertensive efficacy and the effect on renal function of angiotensin‐converting‐enzyme (ACE) inhibitor therapy in renal transplant recipients was evaluated. Posttransplant hypertension resistant to conventional antihypertensive therapy with diuretic, betablocking agent and vasodilator as observed in 21 renal transplant recipients was treated with ACE inhibitors. Prior to therapy, renal function was stable with a mean serum creatinine of 204 ± 99 μmol/l. At the end of the treatment period of 1 week to 36 months systolic blood pressure (BP) decreased from 172 ± 19 mmHg to 143 ± 21 mmHg (p < 0.001) and diastolic BP from 101 ± 9 mmHg to 88 ± 9 mmHg (p < 0.001). Renal function remained stable in 14 patients. Seven patients showed an acute increase of serum creatinine of 57 ± 29%. Renal angiography performed in all these patients disclosed 4 patients with transplant artery stenosis (TRAS) and 3 patients with biopsy‐confirmed chronic vascular rejection. After surgical correction or percutaneous transluminal angioplasty and discontinuation of ACE inhibitor therapy, renal insufficiency was reversed in all cases. In conclusion, ACE inhibitor therapy in patients with posttransplant hypertension resistant to conventional antihypertensive triple‐drug therapy shows a satisfactory and sustained antihypertensive efficacy. Acute renal failure associated with ACE inhibitor should raise suspicion of TRAS but acute deterioration of kidney function can also be due to chronic vascular rejection.
Ileal and colon conduits in renal transplantation
Authors: Gruessner Rainer W. G. , Tzardis Periclis J. , Matas Arthur J. , Dunn David L. , Payne William D. , Sutherland David E. R. , Najarian John S. 
Published: September 2024

AbstractTwenty‐five years ago the first case of renal transplantation into an ileal conduit was performed at this institution. Since then, 16 patients (9 females, 7 males) with an average age of 24.8 yr (range 9 to 47 yr) have undergone 19 transplants into intestinal conduits. The indication was neurogenic bladder in 7 cases, major urinary tract abnormalities in 7, and vesicoureteral reflux in 2. In primary transplants, 8 kidneys were from living related donors and 8 from cadaver donors; in retransplants, 1 kidney was from a living related and 2 from cadaver donors. In all but 3 cases the intestinal loop was constructed at least 2 weeks pretransplant. An ileal loop was used in 14 cases; a colon loop in 2. Conduit‐specific complications were: calculi (n = 2), small‐bowel‐to‐ileal‐loop fistula with hyperchloremic hyperkalemic acidosis (n = 1), urinary fistula (n = 1), and recurrent UTIs (n = 12). Urosepsis caused 4 deaths. As of 9/89, 9 of these 16 patients are alive with functioning grafts (1 retransplant), 1 is alive without a functioning graft, and 6 died [urosepsis (4), ARDS (1), pneumonia (1)]. All of the 9 patients have had functioning grafts for more than 1 yr, 5 for more than 5 yr and 3 for more than 10 yr. Of the 9 functioning grafts, 6 were from living related donors and 3 from cadaver donors. Patients were divided into two groups based on time of transplantation: Group I (11/64–4/77) and Group II (5/77–9/89). In Group I, 6 of 9 patients died; 1 is alive, but without a functioning graft, and only 2 still have functioning grafts. In Group II, no patient has died and 6 of 7 primary grafts still are functioning. Improvements in immunosuppression, surgical technique, infection treatment, and selection criteria are responsible for higher graft and patient survival in Group II.
Coronary artery disease is the major late complication of successful cadaveric renal transplantation
Authors: Mahony John F. , Caterson Robyn J. , Pollock Carol A. , Jones Michael , Waugh David A. , Sheil A. G. Ross 
Published: September 2024

AbstractThe mortality and morbidity due to coronary artery disease (CAD) were determined in a cohort of successful renal transplant recipients. In 133 cadaveric renal allograft recipients who survived at least 10 years (range 10.0–19.4, mean 14.0) from transplantation, 32 subsequently died. The commonest cause of death was myocardial infarction (37.5%), followed by sepsis (25%) and malignancy (16%). The age‐ and sex‐adjusted increase in mortality rate from CAD was 6.76 times that of a normal population. Of the survivors, 23 (24%) have symptomatic (CAD), with half of these having had at least one proven myocardial infarction. As coronary atherosclerosis complicates all phases of renal failure and its treatment, an aggressive approach to controlling the known risk factors is warranted from the earliest stages of renal impairment.
Liposomal amphotericin‐B (AmBisome)® treatment in solid organ and bone marrow transplant recipients. Efficacy and safety evaluation
Authors: Tollemar Jan , Ringdén Olle , Tydén Gunnar 
Published: September 2024

AbstractEight patients, 4 organ and 4 bone marrow transplant recipients, were treated with a liposomal amphotericin‐B formulation (AmBisome) in a compassionate basis program. Time of treatment ranged from 9–48 days (median 15) with a cumulative AmBisome dose ranging from 450–6480 mg (median 963). Maximum dose ranged from 0.9–2.5 mg/kg (median 1.75). Six of the 8 patients with proven or probable deep fungal infection have been discharged from hospital and are well. Two bone marrow‐transplanted patients died during treatment, I was negative for disseminated fungi at autopsy after 8 days of treatment with a total dose of 906 mg AmBisome. Amphotericin B concentrations in tissue samples taken at autopsy ranged from 25 to 281 μg/g tissue in bone marrow, liver and spleen and from 0.6 to 8 in lung, heart, muscle and kidney. In the other patient, who died after 14 d of treatment with a total dose of 1020 mg AmBisome, autopsy was denied. Two patients developed high alkaline phosphatases during treatment. Otherwise, AmBisome was well‐tolerated in all patients without acute side effects.
Kidney transplantation in older patients
Authors: Howard Richard J. , Pfaff William W. , Scornik Juan C. , Salomon Daniel R. , Peterson John C. , Branson Mathew E. 
Published: September 2024

AbstractOlder patients are commonly believed not do as well as younger patients following renal transplantation. Between 1971 and 1988, we performed 88 kidney transplants in patients at least 55 years old. The 1‐yr graft and patient survival for recipients of first cadaver grafts for the entire series were 72.2% and 83.3%, respectively. These survival rates did not differ significantly from patients less than 55 yr old (graft and patient survival 69.0% and 88.6%, respectively, p > 0.05). For recipients of first related grafts at least 55 yr old, 1‐yr graft and patient survival were both 83.3% compared to 83.3% and 94.7% for patients less than 55 yr old (p > 0.05). For the most recent 5‐yr period, 1984‐1988, 1‐yr graft and patient survival of first cadaver grafts were 79.3% and 89.7%, respectively, for older patients compared to 77.3% and 92.3% for younger patients (p > 0.05). Older patients did not have a higher complication rate than younger patients. We believe that there should no longer be an arbitrary upper age limit to renal transplantation. The decision for or against transplantation should be based on the capacity to recover from the operation and to have one's physiologic and psychosocial status improved.
Transplantation of a polycystic kidney from a young cadaver donor
Authors: Chocair Pedro R. , Vasconez Cesar I. , Nahas William C. , Ianhez Luiz E. , Sabbaqa Emll , Arap Sami 
Published: September 2024

AbstractThe course of a diabetic patient receiving a polycystic kidney from a young cadaver donor with 14 cm in its greatest axis, good renal function and creatinine of 1.5 mg% is reported. After 3 years of follow‐up, no changes were observed in the cysts nor in the size of the kidney. The renal function remains steady and there is no infection, nor any other urinary complication. We believe that, in special circumstances, cadaver kidneys with major abnormalities might be used.
Clinical correlation of cytomegalovirus cultures, serology and lymphocyte counts following renal transplantation
Authors: Herchline Thomas E. , Para Michael , Tesi Raymond 
Published: September 2024

Abstract:Cytomegalovirus (CMV) is known to be one of the major pathogens in the first several months after renal transplantation and may have significant associated morbidity and mortality. Ganciclovir is a drug with anti‐viral activity against CMV, but also has the potential for bone marrow toxicity. Therefore it is essential to identify patients at risk for CMV‐associated morbidity or mortality. Forty‐three patients who underwent renal transplantation and subsequently required readmission were reviewed for evidence of CMV infection and for parameters predictive of a need for ganciclovir. Patients who had positive CMV blood cultures were more likely to be symptomatic than asymptomatic, and symptomatic patients were viremic sooner than asymptomatic patients. Positive urine cultures and positive CMV IgM were not predictive of symptomatic infection. CD8 percentages increased in both primary infection and reinfection/reactivation (primary > reinfection/reactivation), but these changes were not predictive of symptomatic infection. These findings confirm previous reports regarding serology and cultures, but suggest that lymphocyte subpopulation counts may not be clinically useful for determining the need for anti‐viral therapy.
Renal transplantation into ileal conduits: Results and long‐term follow‐up
Authors: Jacoby K. , Banowsky L. H. W. 
Published: September 2024

Abstract:From 1977 through 1990, 708 renal transplants were performed at our institution. Eight of these allografts (1.1%) were placed into recipients who required ileal conduits. This report describes the long‐term follow‐up of these patients. Five out of 8 patients currently have functioning allografts 29 to 102 months after transplantation (with a mean allograft survival of 50 months). Construction of an ileal conduit in patients without bladders or in those who have non‐functioning bladders is a straightforward approach with minimal increased morbidity and good long‐term results.
Multiorgan procurement does not affect the immediate outcome of kidney transplants1
Authors: Morel Philippe , Troppmann Christoph , Almond P. Stephen , Schlumpf Rolf , Gillingham Kristen J. , Sutherland David E. R. , Dunn David L. , Payne William D. , Matas Arthur J. , Najarian John S. 
Published: September 2024

Abstract:The increasing number of organs required for transplantation has given an impetus to the development of techniques of multiorgan procurement from a single cadaver donor. We studied the effect of these techniques on the short‐term outcome of kidney transplants. Between 1.1985 and 12.1989, 168 kidneys were procured by our team during multiorgan harvests, 166 of which were transplanted in our institution or elsewhere. Follow‐up could be obtained for 161. The pancreas was retrieved simultaneously in 14 cases (9%); the pancreas and the liver in 34 (21%); the pancreas, the liver, and the heart in 73 (45%); the pancreas, the liver, the heart and the lungs in 24 (15%); the pancreas and the heart in 4 (2%); and the pancreas, the heart and the lungs in 2 (1%). We have incomplete information for 10 kidneys (7%). Immediate graft function occurred in 125 grafts (78%) (Group I); 31 kidneys (19%) had delayed graft function (DGF), 4 (2%) had technical failure (TF) (thrombosis), and 1 (1%) was a primary nonfunction (PNF) (Group II). Comparison with historical controls suggests that multiorgan retrieval had no impact on the incidence of DGF. Multivariate analysis demonstrated that the determinant factor in immediate graft function was the length of preservation – 20 ± 8 hours for Group I vs 26 ± 8 for Group II. Patients with DGF had normal creatinine values at 3 and 6 months, similar to those with immediate function. We conclude that the combined simultaneous procurement of the kidney and other organs does not affect the outcome of the kidney transplant. DGF is related to perservation time.
Factors affecting measurement of urinary amylase after bladder‐drained pancreas transplantation
Authors: Nankivell B. J. , Allen R. D. M. , Bell B. , Taylor N. , Wilson T. , Grierson J. M. , Greenberg M. , Chapman J. R. 
Published: September 2024

Abstract:Urinary amylase activity (UA) was evaluated in 14 diabetic patients receiving bladder‐drained whole pancreas transplants. Amylase was dependent upon pH with optimal activity at pH 7. Increasing acidity led to a substantial loss of measured UA (45% remaining at pH 4, 73% at pH 5, 86% at pH 6, p < 0.001); however, UA was stable at room temperature if the pH was kept constant. On the day after transplantation, a transient peak in UA was followed by a trough lasting a median of 3 days. Thereafter the UA rose steadily, with the rate of rise being faster if the pancreas donor was less than 30 years of age (p < 0.05). Maximal UA values were observed between 3‐6 months after transplantation. High protein and fat liquid test meals, designed to stimulate exocrine secretion, produced an 83% rise in UA (p = 0.02), which was not observed when water was given (n = 8, p = 0.007, differences at 1 hour). Fasting for 17.6 ± 2.1 h (mean ± SEM) produced a 29 ± 6% fall in 24‐h UA, without any measurable change in other parameters of renal or pancreatic function. A fall of 50% in 24‐h UA over 7 d was compared with pancreas biopsy (n = 40) for predicting rejection, and showed a sensitivity of 60% and a specificity of 93%. In 3 patients a false‐negative result occurred in the first few days after transplantation at a time when the UA failed to rise as normally expected. Understanding and eliminating some of the factors which cause variability in UA may improve the interpretation of 24‐h UA measurements in bladder‐drained pancreas allografts.
Asecretory myeloma in a renal transplant recipient
Authors: Bowen P. Allen , Caruana Ralph J. , Pantazis Cooley , Humphries Arthur L. 
Published: September 2024

Abstract:We report the diagnostic and therapeutic problems of a patient who developed an asecretory, widely metastatic myeloma 4 years after renal transplantation. B‐ccll lymphoproliferative disorders are well‐described in the setting of organ transplantation but the occurrence of myeloma is decidedly rare. While the nature of the association between this patient's myeloma and the immunosuppressive regimen received is unclear, the history of clinical transplantation suggests that clinicians may be faced with changing patterns of neoplasia with advances in immunosuppression.
Quality of life after liver transplantation
Authors: Küchler Thomas , Kober Bernd , Broelsch Chrlstoph , Kremer Bernd , Henne‐Bruns Doris 
Published: September 2024

Because of the increasing number of liver transplantations with longer periods of transplant function, there is a growing need for quality of life research in this field. (see: Consensus Conference on Quality of Life Assessment in Surgery, 1989). In addition to morbidity, mortality and rehabilitation, parameters of “Quality of Life” are evaluated: the patient's rating of his subjective physical symptoms, psychological condition (anxiety, depression and mental adjustment), social reintegration and life satisfaction. Using the methods developed by the Hamburg study group on “Quality of Life in Surgery” 38 liver transplantation patients at the University of Chicago (cross‐sectional‐study with control groups of patients with chronic liver disease as well as healthy individuals) and 29 patients at the University Clinic of Hamburg (longitudinal study with points of evaluation before and 3, 6, 12, 24 and 36 months after transplantation) have been evaluated. First results: 1. All successfully transplanted patients show a significant postoperative increase of their overall quality of life. 2. The psychological parameters of quality of life are only partly correlated with physical symptoms. 3. There is a high correlation between rejection episodes and the decrease of all quality of life parameters. 4. In both samples men have a lower quality of life than women. 5. Preoperative depression and lack of social support might be considered as being possible risk factors for long‐term survival. 6. Long‐term survivors rate their quality of life significantly higher than patients with chronic liver disease and despite persisting somatic restrictions, as high as healthy controls.
A safer renal allograft needle biopsy
Authors: Dixon Timothy K. , III James S. Bowman , Sago Alvin L. , Jaffers Gregory 
Published: September 2024

Histologic tissue evaluation remains the most accurate method for the assessment of renal allograft dysfunction, even though numerous noninvasive techniques exist. Reliable biopsy techniques have previously consisted of surgical biopsy or Tru‐cut (14 g) needle biopsy. Complications are infrequent but serious complications have prevented widespread use and thus management of acute allograft dysfunction often entails monitoring clinical responses to empiric therapy based on nonspecific findings from noninvasive studies. We performed percutaneous renal allograft biopsies using the Bard Biopty Gun (18 g) needle with ultrasound guidance and compared the results with prior percutaneous Tru‐cut needle biopsies. Using the Biopty technique, 128 allograft biopsies were performed and compared to 121 prior Tru‐cut needle biopsies. The Biopty technique resulted in one (0.8%) major complication, a perinephric hematoma, as compared to 7 (5.8%) major complications, including loss of 2 (1.7%) allografts, with Tru‐cut needle biopsies. The Bard Biopty needle technique offers a method to provide safer renal allograft biopsies that can be repeated at frequent intervals, facilitating accurate assessment of allograft dysfunction.
Successful kidney transplantation in the presence of IgM alloantibodies
Authors: McCalmon Robert T. , Spees Everett K. , Tardif Gilman N. , Kuruvila K. Chakko , Kortz Warren J. , Kam Igal , Karrer Frederick M. 
Published: September 2024

The presence of anti‐donor IgM lymphocytotoxic antibodies in transplant recipient sera has been suggested as being clinically insignificant with regard to immediate and/or early graft survival. We have transplanted 20 cadaveric kidneys since June 1988 into recipients whose “extended standard crossmatch” was positive but whose crossmatch was negative after treating the sera with dithiothreitol (DTT). Within this group, 16 recipients received a primary kidney graft and 4 individuals had underlying connective tissue diseases. However, only one of these patients was auto‐crossmatch positive. Nine patients had a percent reactive antibody (pRA) level greater than 50% at the time of transplantation. Fourteen individuals had a positive T‐cell crossmatch, and all 20 had a positive B‐cell crossmatch. Seventeen of the 20 patients transplanted are alive. Four patients demonstrated delayed graft function. One patient died of pneumonia, 1 patient died of infectious complications, and 1 patient developed a coagulopathy and infarcted his kidney and mesenteric blood vessels. One patient had an accelerated humoral rejection which was reversed after plasmapheresis (X7). Fourteen of 20 recipients (70%), 13 of whom are 15 to 27 months posttransplant, are doing well with an average serum creatinine of 1.53 mg/dl. These results indicated that one can successfully transplant a kidney into a recipient whose positive crossmatch was due to IgM alloantibodies.
Analysis of plasma interleukin‐2 receptor (sIL‐2R) and tumor necrosis factor‐alpha (TNF‐α) in renal transplant patients
Authors: Noronha Irene L , Daniel Volker , Möhring Klaus , Opelz Gerhard 
Published: September 2024

Abstract:In an attempt to elucidate the role of soluble interleukin‐2 receptor (sIL‐2R) and tumor necrosis factor‐α (TNF‐α) in renal allograft reaction, we tested plasma samples of 68 renal transplant patients using a sandwich enzyme immunoassay and an immunoradiometric assay. Patients with stable renal function demonstrated increased sIL‐2R levels (946 ±34 vs 361 ± 17 U/ml in healthy controls, mean ±SEM; p<0.0001). During acute rejection episodes the level of sIL‐2R was significantly higher (1987± 147 U/ml; p<0.0001). The highest level was observed during OKT3 treatment (3636±511 U/ml; p<0.0001). Patients with cyclosporine A (CyA) nephrotoxicity presented values similar to those of patients with stable allograft function (757 ±71 U/ml; ns). In 8 patients with viral infections the sIL‐2R plasma levels were also elevated (2651 ±412 U/ml; p<0.0001 compared to stable renal function; ns compared to acute rejection and OKT3 therapy). sIL‐2R was also augmented in uremic patients (1452± 62 U/ml). TNF‐α plasma levels were consistently low or sometimes undetectable in normal individuals, patients with stable renal function, and patients with CyA nephrotoxicity (2 ±0.7, 7± 1.5, 1 ±0.7 pg/ml, respectively). Patients with acute rejection had increased plasma TNF‐α (55± 14 pg/ml; p<0.05), especially after OKT3 therapy (157±24 pg/ml; p < 0.05). Six patients with viral infections had plasma TNF‐α levels similar to those found during acute rejection (49 ±9 pg/ml; ns compared to acute rejection; p<0.05 compared to stable renal function). Pretransplant uremic patients presented elevated plasma TNF‐α (56±9.8 pg/ml: p< 0.0001 compared to stable renal function; ns compared to acute rejection). In a scries of in vitro experiments, sIL‐2R and TNF‐α concentrations were measured in the supernatant of peripheral blood mononuclear cells (PBMC) submitted to in vitro stimuli. Both sIL‐2R and TNF‐α increased progressively with time in the supernatant of PBMC stimulated with Phytohemagglutinin (PHA) or OKT3. We conclude that both sIL‐2R and TNF‐α plasma levels are significantly elevated during acute rejection episodes, viral infections and in uremic patients but not during periods of CyA nephrotoxicity. OKT3 is a potent inducer of sIL‐2R and TNF‐α release, demonstrated both in vivo and in vitro.
Effect of the simultaneous administration of rifampicin and erythromycin on the metabolism of cyclosporine
Authors: Soto J. , Sacristan J. A. , Alsar M. J. 
Published: September 2024

Abstract:The administration of erythromycin plus rifampicin in a cardiac transplant produced a fall in cyclosporine blood concentrations when, in the same patient, 2 weeks previously the administration of erythromycin alone produced an increase in cyclosporine blood concentrations that reached the toxic range. When these two antibiotic are given together with cyclosporine, the inducing effect of rifampicin is greater than the inhibitory effect of erythromycin. Since the maintenance dose of cyclosporine should not be reduced, cyclosporine blood concentration should be routinely monitored to keep it within the therapeutic range.