bluuebunny/crossref_metadata_2025_split huggingface dataset:
High survival rate of kidney transplants in IgA nephropathy patients
Authors: Lim Eduardo C. , Terasaki Paul I. 
Published: September 2024

BackgroundPatients with various diseases such as chronic glomerulonephritis (CGN), pyelonephritis (PN), polycystic kidney disease (PKD), etc., have had remarkably similar kidney graft survival rates. It was interesting to see if patients with IgA nephropathy (IgAN), who have associated immunologic dysfunctions, might have an unusual response to their kidney allografts.MethodsThe graft survival rates of 374 patients with IgAN were compared to those of patients with other diseases from data submitted the UCLA Transplant Registry by over 200 different centers.ResultsThe 5‐year cadaver donor graft survival rate in patients with IgAN was 76%, compared to 60% for controls (PN, PKD and CGN). Matching IgAN for age, sex, and race at 4 yr still yielded significantly higher graft survival of 86% compared to 68% for controls. Functional graft survival, which counts death as lost‐to‐follow‐up, was also higher at 5 yr among IgAN patients (77%) compared to controls (66%). Grafts from HLA‐identical sibling donors and 1‐haplotype‐matched related donors also had higher survival in IgAN recipients than in patients with other diseases. Thirty‐four IgAN‐sensitized patients with preformed cytotoxic antibodies had a 97% 5‐year graft survival rate. Graft survival to 5 yr among 60 patients with IgAN who were not transfused was 90%. Transfusion reduced the graft survival to 84% at 1 yr and 73% at 5 yr.ConclusionPatients with IgAN have higher kidney allograft survival rates than patients with CGN, PN, PKD. Immunologic dysfunction in IgAN patients is probably responsible for higher kidney allograft survival in those patients, and may provide clues as to how similar results can be achieved for other patients.
Role of lipid disturbances in the atherosclerosis of renal transplant patients
Authors: Abdulmassih Zlad , Chevalier Alain , Bader Cyrille , Drüeke Tilman B. , Kreis Henri , Lacour Bernard 
Published: September 2024

Atherosclerosis is a major long‐term complication of renal transplantation. In the present retrospective study, we examined the possible role of lipid disturbances as a pathogenetic risk factor. We used deep‐frozen sera from 54 kidney graft recipients with a follow‐up of 11.8 ± 4.2 yr (mean ± SD) after transplantation: 25 patients with one or more ischemic event(s) and 29 with none. The two groups were matched for age, sex, body weight and height, duration of chronic renal failure before and time after transplantation. The serum samples had been drawn 1‐6 months prior to the first vascular event in patients with cardiovascular accident and the length of serum storage time was comparable in patients without cardiovascular accident. The major finding was that patients with cardiovascular accident had significantly higher serum total cholesterol (p < 0.02), triglycerides (p < 0.001), apolipoprotein (apo) B (p < 0.003), apo CII (p < 0.02), apo CIII (p < 0.006), and apo E levels (p < 0.006) than patients without cadiovascular accident. By discriminant factor analysis, 70% of patients were correctly allocated to the respective group on the basis of combined triglycerides, apo B and apo E levels. In addition to serum lipids, three other risk factors were identified, namely cigarette smoking, antihypertensive drug therapy, and atherosclerotic lesions of the iliac artery at time of transplantation. In conclusion, disturbances of lipoprotein metabolism probably favor the occurrence of ischemic vascular disease in kidney graft recipients.
Treatment of a B‐cell lymphoproliferative disorder in a liver transplant patient with interferon alfa and gamma globulin: A case report
Authors: Kane R. E. , Bunchman T. E. , Vogler G. , Brems J. J. 
Published: September 2024

Epstein‐Barr virus (EBV) infection in immunosuppressed organ transplant recipients has been associated with the development of lymphoproliferative disorders (LPD), including malignant lymphoma of the gastrointestinal tract. A 4‐year‐old boy who received a liver transplant for acute fulminant hepatitis C developed steroid‐resistant rejection 3 weeks after transplant which was successfully treated with the monoclonal antibody, OKT3. Three months post‐transplant he developed fevers, severe watery diarrhea and a protein‐losing enteropathy. Endoseopy revealed EBV‐positive LPD of the jejunum so he was started on acyclovir and his immunosuppression decreased. Ten days later he was explored surgically because of a perforation of a lymphomatous tumor mass in the ileum. Two areas of lymphomatous tumor were resected in the mid‐jejunum and ileum. Cytomorphology and immunoperoxidase stains of the small bowel tumors and mesenteric nodes were consistent with a EBV‐driven, polyclonal, polymorphous B‐cell LPD. He was treated with interferon alpha 3 times/wk and gamma globulin infusions weekly for 4 months. There was no evidence of recurrence of the LPD despite conventional immunosuppression with cyclosporine and prednisone. In this patient, surgical resection of small bowel tumors, followed by reduced immunosuppression and treatment with interferon alpha, gamma globulin and acyclovir were successful in treating a EBV‐driven LPD without compromise of the liver allograft.
Flow cytometry PRA, a new test that is highly correlated with graft survival
Authors: Cicciarelli J. , Helstab K. , Mendez R. 
Published: September 2024

IgM antibodies present in the recipient sera are not necessarily harmful to the outcome of the graft. However, one primarily measures IgM with panel‐reactive antibody (PRA) determined by microcytotoxicity. In order to develop a potentially more correlative PRA measurement, we have utilized the flow cytometer to measure IgG antibody to a panel of lymphocytes representing HLA antigens. This was accomplished by measuring the median channel shift associated with the patient's serum antibody binding to pooled target cells. The correlation between flow PRA and graft outcome was analyzed in 59 regraft recipients using current serum prior to transplantation. The PRA was determined by both cytotoxicity and flow cytometry. One‐year follow up was available on all transplant recipients with 62% 1‐yr actuarial graft survival. Cytotoxic PRAs were divided into greater than 10% and less than or equal to 10%, with a 72% vs 70% graft survival at 6 months and 62% vs 62% 1 yr graft survival, respectively. Flow cytometry PRA was divided into greater than 10 and less than or equal to 10 channel shift with 63% vs 86% graft survival at 6 months, and 53 vs 79% 1 yr graft survival respectively (p < 0.05 for both time intervals). Serum creatinine levels were concomitantly lower at 1 and 3 months in the flow PRA‐negative recipients. Flow PRA was a simple, rapid test which eliminates “false” positives due to IgM and detects non‐complement fixing IgG, which occurred in 25% of the samples. Flow PRAs were significantly correlated with graft survival and represented a new test which can be utilized as an in vitro correlate for immune response in the transplant candidate.
Risk factors associated with the development of squamous cell carcinomas in immunosuppressed renal transplant recipients
Authors: Roeger L. S. , Shell A. G. R. , Disney A. P. S. , Mathew T. H. , Amiss N. 
Published: September 2024

The risk factors associated with the development of squamous cell carcinomas (SCC) in immunosuppressed renal transplant recipients were assessed. Data concerning 2573 patients aged 18 years or older at the time of renal transplantation between January 1, 1981 and October 31, 1989 were extracted from the Australia and New Zealand Combined Dialysis and Transplant Registry (ANZDATA). Certain groups of patients, including those with a diminished (non‐caucasians [p < 0.01]) or increased (those with SCC prior to or within 90 days of transplantation [p < 0.01]) risk of developing SCC were excluded. A final sample of 2115 patients was derived, 122 or whom developed a SCC. Statistical analyses of a number of potential risk factors were made. Increased age at the time of transplantation was shown to be a significant risk factor (p < 0.01). Patients who received their grafts in transplant units with increased sun exposure (lower latitude) were at significantly greater risk (p < 0.01). Females tended to be at less risk (p < 0.10) than males. The type of donor (living or cadaver) and whether or not the patient received immunosuppression for greater than 3 months pre‐dialysis were not significant factors. There were no significant differences in risk of SCC development amongst patients with different primary renal diseases (although patients with diabetes tended (p < 0.10) to be at less risk than patients diagnosed with glomerulonephritis), those analyzed according to tissue matching results, or those with cytotoxic antibodies in their sera at the time of transplantation. Higher levels of the maximum serum cytotoxic antibody reactivity were found to be associated with decreased risk (p < 0.05). There was no significant difference in the risk of groups of patients treated with a variety of different immunosuppressive regimes. Patients treated with cyclosporine, alone or in combinatinn with other agents, were at similar risk to those receiving azathioprine and prednisolone. It appears that the increased risk of SCC development in renal transplant recipients immunosuppressed with azathioprine will persist in the cyclosporine era.
Post‐transplant lymphoproliferative disease in cardiac transplant patients receiving OKT3 therapy
Authors: Ratkovec Ranae M. , O'Connell John B. , Bristow Michael R. , Jones Kent W. , Gay William A. , Rasmussen Linda G. , Renlund Dale G. , Program The UTAH Cardiac Transplant 
Published: September 2024

An increased incidence of malignancy has been observed in recipients of organ transplantation, with a large proportion of the tumors comprised of lymphoproliferative disorders. A recent report implicating OKT3 in the development of a marked increase in the frequency of lymphoma has stimulated controversy regarding the safety of OKT3 in organ transplantation. To determine the incidence of post‐transplant lymphoproliferative disorder (PTLD) in a large cohort of patients receiving OKT3, and to determine if a correlation exists between the dose of OKT3 and the development of PTLD, we reviewed the clinical course of 305 cardiac transplant recipients given OKT3. The indication for OKT3 therapy was rejection prophylaxis in 246 (80.7%), treatment of acute rejection in 11 (3.6%), or for both indications in 48 (15.7%). The mean follow‐up period was 27.7 ± 18 months. A diagnosis of post‐transplant lymphoproliferative disorder was made at 16.3 ± 14 months post‐transplantation in 4 (1.3%) of the 305 patients. In patients with PTLD, the total OKT3 dose was similar to those without PTLD (m ± sem, 78.8 mg ± 14.2 vs. 74.7 mg ± 1.4; p = NS). Furthermore, the incidence of PTLD in the 69 patients who received more than 75 mg of OKT3 was not significantly different when compared with the 236 patients who received ≤ 75 mg of OKT3 (2.85% vs. 0.8%; p = NS). Of the 4 patients who developed a PTLD, 3 had an abdominal immunoblastic (large cell) lymphoma and died within 6 months of diagnosis. The patient with a polymorphic lymphoid proliferation in the lung was in clinical remission; however, he died from sepsis 10 months after the diagnosis of PTLD. At autopsy, he was found to have immunoblastic lymphoma. We conclude that, in a large population of cardiac transplant patients receiving OKT3, the incidence of post‐transplant lymphoproliferative disorders is low (1.3%) and that OKT3 therapy alone does not account for an increase in the prevalence of PTLD, as previously reported.
Allogeneic microchimerism and donor antigen‐specific hyporeactivity in lung transplant recipients
Authors: McSherry Cynthia , Hertz Marshall I. , Jackson Annette M. , Butters Kim , Diko Michael , Matas Arthur J. , Bolman R. Morton , Reinsmoen Nancy L. 
Published: September 2024

The identification of peripheral donor cells in solid organ transplant recipients has led to speculation as to the tolerogenic role of circulating donor cells. Also being debated is the possible significance of persistent donor alloantigen‐presenting cells in inducing and maintaining an alloantigen‐specific unresponsive state. Previously, we showed that donor antigen‐specific hyporeactivity is a useful marker for identifying kidney, lung, or heart recipients at low risk for immunologic complications; we found donor antigen‐specific hyporeactivity in 25% of kidney, 35% of lung, and 22% of heart recipients. All 3 hyporeactive subgroups experienced fewer late (>3 months) rejection episodes and a lower incidence of chronic rejection. The purpose of the current study was to determine whether peripheral blood microchimerism correlates with the development of donor antigen‐specific hyporeactivity and affects clinical outcome. We correlated the detection of microchimerism with in vitro proliferative response to donor antigen in 19 lung recipients who were ≥12 months posttransplant. Allogeneic peripheral blood microchimerism was studied. with a PCR‐based limiting detection assay using HLA‐DR sequence‐specific primers. We detected microchimerism in 47% (9 of 19) of the lung recipients tested. All recipients who were donor antigen‐specific hyporesponsive had microchimerism, and all recipients without detectable microchimerism were responsive to donor antigen. However, not all recipients with microchimerism developed donor antigen‐specific hyporeactivity. Further, none of the hyporesponsive recipients has been diagnosed with obliterative bronchiolitis (OB). In contrast, 2 of the 4 with microchimerism who were responsive to donor antigen have been diagnosed with OB, as have 5 of the 10 who were negative for both hyporeactivity and microchimerism.Thus, long‐term graft outcome may correlate more closely with donor antigen‐specific hyporeactivity than with microchimerism.
Fate of renal allografts connected to vascular prostheses
Authors: van der Vliet J. Adam , Naafs Dick B.J. , van Bockel J. Hajo , Kootstra Gauke , Boll Albert P.M. , Barendregt Wouter B. , Buskens Frans G.M. 
Published: September 2024

ObjectiveThe outcome of renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is evaluated.Patients and MethodsAll 7 Dutch transplant centers were invited to review their experience. Among a total of 5791 cadaveric renal transplantations performed between 1978 and 1994, 13 cases (0.2%) in 3 different centres were identified. In 6 cases the vascular reconstruction and transplant operation were performed simultaneously, and in 7 cases separately, with a mean interval of 3.5 yr. The indications for vascular reconstruction were aneurysmal disease in 4 and obstructive disease in 9 cases.ResultsThe early vascular complications of these procedures were hemorrhage in 4 and renal vein thrombosis in 1 and led to graft loss in 3 cases. The perioperative mortality was 2/13 (15%). The graft and patient survival were 68 and 83% respectively after 1 yr and 17 and 37% after 5 yr. Late mortality was mainly due to cardiovascular disease.ConclusionsRenal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is a hazardous procedure with relatively poor shortand long‐term results. These observations shoud be considered in the choice of renal replacement therapy in this special patient population.
Factors on graft survival of living donor kidney transplantation in a single center
Authors: Jin Dong Chan , Yoon Young Suk , Kim Yong Soo , Yoon Sun Ae , Ahn Seog Ju , Kim Suk Young , Chang Yoon Sik , Bang Byung Kee , Koh Yong Bok 
Published: September 2024

AbstractWe analyzed the potential factors that could influence the survival of graft, focused on primary graft living‐donor kidney transplantation with cyclosporine (CSA) therapy. 680 cases were enrolled in this study. Patients and graft survival rates were calculated by a Kaplan‐Meier product limit estimate with a 1‐day time interval. The analyzed variables were donor relationship, HLA matching, recipient age and sex, donor age and sex, ABO blood type compatibility, diabetic status, hepatitis virus infection, donor specific or non‐specific blood transfusion and acute rejection episode. The results suggested that acute rejection episode was the worst prognostic factor in graft survival. An HLA‐matched donor and a young male donor, i.e. a greater donor nephron mass for less recipient body mass, will show better long‐term survival. Diabetes and hepatitis B infection have some negative effects on the long‐term survival of graft kidney, but age of recipient, donor‐specific transfusion and donor‐recipient relationship have little effect.
A third kidney transplant: cost‐effective treatment for end‐stage renal disease?
Authors: Matas Arthur J. , Gillingham Kristen J. , Payne William D. , Dunn David L. , Gruessner Rainer W. G. , Sutherland David E. R. , Schmidt Walter , Najarian John S. 
Published: September 2024

AbstractGiven the organ donor shortage, some question whether a third kidney transplant can be justified. We studied the outcome of 51 third transplants (mean age 28±2 yr) done between 1 January 1985 and 31 December 1994. We compared hospital stay (mean±S.E.), cost, readmissions, readmission days, and outcome of third (vs. first and second) transplants. We found that patient survival for third transplants was equivalent to first and second transplants; graft survival was not as good. However, when third transplant recipients with recurrent disease (specifically, hemolytic uremic syndrome and focal sclerosis) were excluded from our analysis, we found no difference in 5‐yr graft survival (vs. first or second transplant recipients).Of the 51 third transplant recipients, 41 had a cadaver donor transplant. Third cadaver transplant recipients tended to have a longer hospital stay (p=NS) than first cadaver transplant recipients but had no more readmissions or readmission days than first or second cadaver transplant recipients.Employment data are available for 28 third transplant recipients; 16 (57%) are currently working or going to school. Of the 21 recipients who responded to quality of life questionnaires, 17 (81%) reported being healthy and all 21 (100%) said transplantation was not a drawback to their health. We conclude that third transplants should be considered for selected patients with renal failure whose first or second transplants have failed. Such patients can often be successfully transplanted.
Volume‐mediated pulmonary responses in liver transplant candidates
Authors: Kuo Paul C. , Schroeder Rebecca A. , Vagelos Randall H. , Valantine Hannah , Garcia Gabriel , Alfrey Edward J. , Haddow Gordon , Dafoe Donald C. 
Published: September 2024

AbstractPulmonary hypertension, defined as mean pulmonary artery pressure (mPAP) greater than or equal to 25 mmHg, is a recognized complication of hepatic dysfunction with portal hypertension and is considered a relative contraindication to liver transplantation. To characterize pulmonary hemodynamic responses in OLT candidates without pre‐existing primary pulmonary hypertension, 22 consecutive patients referred for OLT at the Stanford University Hospital underwent prospective right heart catheterization with pressure determinations at baseline and following infusion of 1 1 of crystalloid over 10 min. In addition, EKG, chest X‐ray and transthoracic echocardiograms were performed as a part of the routine evaluation. Eleven non‐cirrhotic patients served as controls. At baseline, 1/22 (4.5%) OLT patients had pulmonary hypertension while 9/22 (41%) developed pulmonary hypertension following volume infusion (p<0.0001). In contrast, 0/11 controls manifested elevated pulmonary pressures at baseline or following volume challenge. OLT candidates were found to have significant increases in mean pulmonary pressure and capillary wedge pressure (PCWP) compared to controls, suggesting intravascular volume overload or left ventricular dysfunction as potential causes. OLT candidates who manifested volume‐dependent pulmonary hypertension (a) had a 2‐fold higher baseline PCWP, (b) currently smoked, and (c) had previously undergone portosystemic shunts. Aggregate analysis of EKG, echo and CXR for determination of volume‐mediated pulmonary hypertension revealed a sensitivity of 25%, specificity of 75% and a positive predictive value of 40%. Preoperative identification of patients with a predisposition to manifesting elevated pulmonary pressures in the context of rapid volume infusion offers the potential for improved risk stratification and optimized clinical management.
Impact of first acute rejection episode and severity of rejection on cadaveric renal allograft survival*
Authors: Hariharan S. , Alexander J. W. , Schroeder T. J. , First M. R. 
Published: September 2024

AbstractA total of 504 renal transplants were performed between 1984 and 1993; 408 (81%) were cadaver grafts. This study evaluated the impact of a first acute rejection episode and the severity of the rejection on cadaveric allograft survival. Acute allograft rejection was based on clinical evaluation and confirmed by renal biopsy. Ten patients were excluded from this study due to early patient or graft loss. Patients were divided into Group I (n=179), who never experienced acute rejection, and Group II (n=219), who had an acute rejection episode. Group II patients were divided into IIA (n=140), who had a mild first acute rejection episode treated with methylprednisolone, and IIB (n=79), who had moderate or severe acute rejection treated with OKT3. The overall 1‐, 2‐, 3‐, and 5‐yr actuarial cadaveric renal allograft survival for Group I was 80%, 76%, 74%, and 68%. The corresponding graft survival for Groups IIA and IIB were 75%, 63%, 58%, and 50%; and 79%, 71%, 65%, and 53% [p=0.03 (I vs. IIA), p=NS (I vs. IIB and IIA vs. IIB)]. A similar pattern of survival was seen in primary kidney allograft recipients. In conclusion, longterm graft survival was superior in patients who never experienced acute rejection compared to those with rejection. Improvements in long‐term graft survival can be accomplished in patients with severe rejection with OKT3 treatment resulting in comparable survival to those with mild rejection.
Early ganciclovir therapy effectively controls viremia and avoids the need for cytomegalovirus (CMV) prophylaxis in renal transplant patients with cytomegalovirus antigenemia
Authors: Gotti Eliana , Suter Fredy , Baruzzo Sara , Perani Vincenza , Moioli Fausto , Remuzzi Giuseppe 
Published: September 2024

AbstractCytomegalovirus (CMV) infection is still a problem for organ transplant recipients despite studies that long‐term prophylaxis with high dose of acyclovir or ganciclovir given to all organ recipients may limit the consequences of infection and disease. In the present report of 160 consecutive renal transplant patients, we used a diagnostic assay for CMV antigenemia (detection of CMV antigen in peripheral blood leukocytes) and treated with ganciclovir only those patients who had a positive test. No patient in this series had routine prophylaxis. Out of the 160 patients, 71 had clinical and/or laboratory signs of infection, and were tested for early antigen in peripheral leukocytes. The test was positive in 35, all of whom received a course of 3 wk ganciclovir treatment which effectively cured CMV in 34 out of 35. One patient was ganciclovir‐resistant, but responded to foscarnet. None of the 36 patients who had no early antigenemia and did not receive specific treatment developed the disease. The treatment was extremely well tolerated in all our patients with no adverse events. Thus, even though this was not a controlled study, our present results may be taken to indicate that long‐term acyclovir or ganciclovir for all organ transplant recipients might be no longer totally justified. We conclude that detecting viral antigen in circulating leukocytes identifies patients who are indeed at increased risk of developing severe CMV disease. When these patients are treated early enough, CMV is eliminated with a relatively short course of ganciclovir, which has virtually no side effects.