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Query: UMLS:C0009443 (cold)
 92,137 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To compare the effect of type of induction immunosuppression on the quality of initial renal allograft function, we identified 35 cadaver donor kidney pairs in which one recipient of a kidney from a given pair received induction immunosuppression with Minnesota antilymphocyte globulin (MALG group) while the recipient of the contra-lateral kidney received cyclosporine from day zero (CsA group). In the absence of an existing quantitative measure to assess and compare the status of those grafts that function primarily, we defined the half-life of creatinine elimination (t1/2SCr) as such an outcome measure based on a review of creatinine elimination kinetics. All organs were procured with in-situ perfusion and en-bloc removal. Total cold storage times, rewarm times, and perioperative management were comparable for the two groups. In the MALG group, the mean t1/2SCr) was not different from that in the CsA group (1.38 +/- 0.96 days vs 1.35 +/- 1.2 days P = NS). Multiple regression analysis performed on the differences in recipient age, number of DR-B locus matches, total cold ischemia time, rewarm time, and central venous pressure at reperfusion of a given donor pair demonstrated no significant impact of any of these differences on the difference in t1/2SCr for the same pair set in this sample. The nadir of serum creatinine achieved in the first five days posttransplant was somewhat higher in the CsA group (234 +/- 131 mumol/L) as compared with the MALG group (200 +/- 132 mumol/L) but the difference was not significant. A similar nonsignificant trend was observed in the comparison of mean serum creatinine values at 30 days posttransplant (MALG group: 158 +/- 62 mumol/L vs. CsA group: 200 +/- 141 mumol/L). Only one of seventy recipients (CsA group) was dialyzed within the first 5 days posttransplant for an overall incidence of ATN of less than 2%. Fourteen of 35 (40%) recipients in both groups received treatment for acute rejection. The mean time to first treatment for acute rejection episode was shorter in the CsA group than the MALG group (10 +/- 8 days vs 23 +/- 24 days, P = 0.055). Graft survival at one year was not different for the two groups (92% vs. 87% for the MALG and CsA groups respectively, P = NS).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The quality of initial function following renal transplantation determined by creatinine elimination kinetics. Comparison of Minnesota antilymphocyte globulin and cyclosporine induction immunosuppression. 175 62

To assess the impact of cadaver donor age on posttransplant renal function and graft survival, we analyzed our clinical results in 17 recipients of younger donor kidneys (less than 10 years) and 48 recipients of older donor kidneys (greater than 50 years) and compared them with a control group of 598 patients who received kidneys from donors between 11 and 50 years of age. The 3 groups were comparable with respect to recipient age, duration of dialysis, prior transfusions, previous transplants, cold ischemia time, HLA AB mismatches, cytotoxic antibody profile, posttransplant ATN, and prophylactic ALG treatment. The cumulative patient survival at 1, 2, and 3 years was not significantly different among the 3 groups, but the graft survival in recipients of older donor kidneys was significantly lower than the control (71% vs. 62% at 2 years, P = .09 and 66% vs. 55% at 3 years, P = .0003. The short-term renal function assessed at 1 month posttransplant was significantly lower in the older donor group compared with the control (creatinine clearance 45 mL/min vs. 59 mL/min, P = .0003). Likewise, the long-term renal function assessed at the last follow-up was also lower in the older donor group than the control (creatinine clearance 40 mL/min vs. 49 mL/min, P = .07). There were no significant differences in graft survival or short- or long-term renal function between the younger donor group and the control group. These observations suggest that transplantation of a kidney from an older cadaver donor is associated with an inferior posttransplant outcome. The practical decision whether or not to use an older donor kidney should be individualized taking this as well as other factors into account.
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PMID:Influence of cadaver donor age on posttransplant renal function and graft outcome. 230 Oct 36

The results of 61 cadaveric allografts preserved for 30 to 76 hours were analyzed to determine the effect of cold ischemia time, the method of preservation, and the type of immunosuppression on early graft viability and long-term graft survival. Preservation in cold storage up to 50 hours gave a low incidence of nonfunction (4%) and of posttransplant dialysis (20%) and a high rate of function both at 1 month (96%) and at 2 years (60%). Cold ischemia time greater than 50 hours caused a significantly increased need for dialysis (58%) but without appreciable difference in graft function at 1 month or at 2 years. Preservation by machine had no advantage over preservation by simple cold storage when the cold ischemia time was less than 50 hours. When cold ischemia time exceeded 50 hours, machine preservation was associated with a significantly reduced incidence of posttransplant dialysis but without significant differences in long-term function at 2 years. With up to 50 hours of cold ischemia and providing there was no ATN, CsA had little nephrotoxicity and gave excellent graft function at 1 month and at 2 years. However, the nephrotoxicity of CsA was markedly increased when the preservation interval exceeded 50 hours, resulting in a significantly increased rate of primary nonfunction and the need for dialysis with a significant decrease in graft function at 1 month and at 2 years. The nephrotoxicity of CsA was considerably decreased or eliminated without affecting its powerful immunosuppressive property when initial immunosuppression was begun with azathioprine with sequential conversion to CsA when graft function was fully established. It is recommended that when cold ischemia is long or when there is ATN, CsA should be used as a sequential therapy to azathioprine after graft diuresis or, alternatively, in much smaller doses as part of a combination therapy with azathioprine.
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PMID:Limiting factors in successful preservation of cadaveric kidneys with ischemia time exceeding 50 hours. 354 9

Of 2457 patients in the North American Pediatric Renal Transplant Cooperative Study registry who were followed for 5481 patient-years after the index transplantation, we observed 136 deaths, for an average annual rate of 24.8 deaths per 1000 patient-years. Death resulted primarily from infection (n = 55, 40%), cardiovascular causes (n = 28, 21%), hemorrhage (n = 16, 12%), and malignancies (n = 9, 7%). Cadaver-donor source was associated with greater mortality (6.7%) than a living-donor source (4.0%) (P < 0.005). Recipients aged 0-1, 2-5, 6-12, and 13-17 years old had mortality rates of 17.5, 8.0, 3.6, and 4.5%, respectively (P < .001). Mortality rates increased substantially when examined by recipient and cadaver donor ages (mortality rates of up to 45%), the greater the concordance between young donor and recipient ages. Interestingly, acute tubular necrosis and graft failure less than 30 days after transplantation (GH30) were each associated with markedly elevated mortality rates. (The risk ratio for ATN was 3.1 [P < 0.001] and for GF30 it was 6.4 [P < 0.001].) Mortality after transplantation was also affected by the underlying renal disease, with high mortality rates observed for oxalosis (n = 21, 33.3%), congenital nephrotic syndrome (n = 79, 15.2%), pyelo/interstitial nephritis (n = 54, 11.1%), and Drash syndrome (n = 14, 21.4%). When the joint effect of these risk factors was examined in a Cox proportional hazards model, young recipient age (0-1 years old) and GF30 were significant (P < .001) risk factors of mortality for recipients of living-donor organs. For recipients of cadaver kidneys, young recipient age--0-1 years old (P < .001) and 2-5 years old (P = .002)--ATN (P = .029), and GF30 (P < .001) were all significant risk factors. Recipient age is the major determinant of increased mortality after renal transplantation. Avoidance of acute tubular necrosis by reducing cold time and preventing early graft failure by better matching techniques in this vulnerable population may improve the mortality rate.
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PMID:Posttransplant deaths and factors that influence the mortality rate in North American children. 811 40

It is known that the earlier the graft begins functioning after cadaver kidney transplantation, the better the graft survival rate and function will be. In order to examine the possibility of shortening the period of acute tubular necrosis (AIN), we retrospectively studied the effect of several factors on the duration of postoperative hemodialysis. The subjects were 27 patients on whom a cadaver kidney transplantation was performed during a 6-year period from July 1, 1986. The mean duration of postoperative hemodialysis was 14.0 days in 26 out of the 27 patients. The remaining patient showed a primary non-functioning kidney. A significant correlation was observed between the anastomosis time and the duration of postoperative hemodialysis. No significant correlations were noted between the duration of postoperative hemodialysis and the age of the donor, renal function during the 24 hours preceding nephrectomy, or cold ischemic time. Moreover, no significant difference was observed in the duration of postoperative hemodialysis between patients using a roller pump for perfusion and patients who did not. The duration of postoperative hemodialysis was significantly shorter in patients using UW solution than in patients using Euro-Collins solution. Graft survival rate 6 months and one year after transplantation was 88.9% and 83.3%, respectively in the EC group, and 100% and 100%, respectively, in the UW group. It was concluded from these results that a short anastomosis time is essential in order to shorten the period of ATN after cadaver kidney transplantation, and that UW solution is effective in shortening the duration of postoperative hemodialysis and improving the graft survival rate thereafter.
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PMID:[Clinical studies of factors influencing acute tubular necrosis after kidney transplantation]. 813 50

Post-transplant cure tubular necrosis (ATN) represents the most frequent cause of delayed graft function in the immediate post-transplant period. Several causes have been associated with the development of post-transplant ATN such as donor and recipient ages, cold-warm ischemia times, HLA mismatches, and postoperative hypotension. In the present study, we retrospectively evaluated the role of secondary hyperparathyroidism and high parathyroid hormone (PTHi) blood levels in the development of post-transplant ATN. One hundred patients submitted to cadaveric renal transplant between January 1992 and March 1993 in our unit were included. Twenty-seven patients (27%) developed post-transplant ATN and seventy-three (73%) did not. Post-transplant ATN was significantly associated with gender (p < 0.01), recipient age (p < 0.01), number of transplantations (p < 0.01), time on hemodialysis (p < 0.001), cold ischemic time (p < 0.05) and PTHi levels (p < 0.001). The bivariate and multivariate statistical analyses demonstrated that the development of post-transplant ATN was significantly more frequent in females; retransplanted patients, patients with a time on dialysis of more than 5 years, recipients over 60 years old, patients with a PTHi blood level higher than 240 pg/ml (4 times normal level) and a cold ischemia time of more than 18 h. Based on these results, we conclude that high PTHi blood levels in the renal transplant recipients represent a relevant factor in the development of post-transplant ATN. The administration of intravenous pulsed of 1,25(OH)2D3 and/or a calcium channel blocker in the perioperative period could be useful to decrease the incidence and severity of post-transplant ATN in these patients.
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PMID:Role of secondary hyperparathyroidism in the development of post-transplant acute tubular necrosis. 874 60

The aim of the prospective study was to assess the exact kidney temperature and the effect of surface cooling of the kidney during the time of vascular anastomosis. Twenty-two renal graft recipients were incorporated into our study. We used an electronic temperature measurer provided with a needle-shaped probe pierced into the body of the kidney. The temperature was recorded every 5 min. The mean temperature of the kidney at the beginning of anastomosis (T0) was 8.87 +/- 3.97 degrees C and 17.95 +/- 5.1 degrees C at the end (Tend). The striking finding of this study was that the mean Tend delayed kidney function-negative in [ATN(-)] recipients was significantly lower than in the ATN(+) group; respectively, 14.86 +/- 3.6 degrees C and 19.71 +/- 5.07 degrees C. Therefore, we have divided all recipients according to Tend (< 15 degrees C and > 15 degrees C) in an attempt to assess the direct influence of kidney temperature on early graft function. In nine cases, a temperature below 15 degrees C was recorded and in 13 cases it exceeded 15 degrees C at the end of anastomosis. The mean cold ischemia time and anastomosis time were not different in these recipients. Delayed graft function occurred in 14 recipients; in 3 of 9 (33.3%) recipients from group Tend < 15 degrees C; and in 11 of 13 (85%) from group Tend > 15 degrees C. One case of primary non-function was observed (Tend > 15 degrees C). This study documents the value of effective cooling of the kidney during the time of vascular anastomosis. Since in most clinical reports the significance of the second warm ischemia was assessed only by the duration of the anastomosis, without measurement of the actual organ temperature, this may explain the different findings in our studies.
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PMID:Effective surface cooling of the kidney during vascular anastomosis decreases the risk of delayed kidney function after transplantation. 895 98

Previous experimental and human data suggests a detrimental effect on the course of acute renal failure related to exposure of blood to artificial dialysis membranes of poor biocompatibility. We performed a 2.5-year prospective randomized trial to compare the clinical course of acute renal failure (post-operative ischemic acute tubular necrosis, ATN) in patients receiving a cadaveric renal transplant requiring supportive hemodialysis in the immediate post-transplant setting. Patients were randomized to either a cuprophane or polymethylmethacrylate (PMMA) conventional hollow fiber dialyzer. All patients received a standard immunosuppressive regimen which included induction therapy with either horse anti-thymocyte gamma globulin (ATGAM) or the murine anti-CD3 monoclonal antibody (OKT3). Of 53 patients randomized, 17 were excluded (2 for intervening biopsy-proven rejection prior to recovery from ATN, 10 for primary graft nonfunction and 5 for other reasons), leaving 36 evaluable cases of uncomplicated ATN, 18 in each group. There was no difference by age, race, gender, cause of ESRD, immunosuppressive regimen, cold or warm ischemia time, use of pre-transplant dialysis, percent oliguria or the incidence of intra-dialytic hypotension between the 2 groups. There was no difference in the mean time to recovery from ATN posttransplant (8.9 days in the cuprophane group vs 9.5 days in the PMMA group, p = NS) or in the average number of hemodialysis treatments required (3.6 in both groups, p = NS). There was also no difference in long term allograft outcome in terms of the nadir serum creatinine, the number of episodes of subsequent acute rejection or in the development of chronic rejection. An intent-to-treat analysis of all 53 originally randomized patients similarly yielded no significant differences. A subsequent, non-randomized study using a membrane of intermediate biocompatibility (Hemophan) also showed no difference in recovery time from ATN. Bioincompatible membranes do not seem to have a significant clinical impact on the course of recovery of this form of acute renal failure. The striking benefits of biocompatibility in the course of ARF seen in other human trials may relate more to the non-renal systemic toxic effects of bioincompatibility.
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PMID:Biocompatible dialysis membranes and acute renal failure: a study in post-operative acute tubular necrosis in cadaveric renal transplant recipients. 898 57

ATN-10, Mn-metalloporphyrin, has been developed as a tumor selective contrast agent for magnetic resonance (MR) imaging. To investigate the tumor specificity of ATN-10, we produced three experimental in vivo models; rat bran tumor (9L glioma) model, vasogenic (cold injury) and cytotoxic brain edema (24-hour MCA occlusion) models. The time course of contrast enhancement was compared after intravenous injection of ATN-10 or Gd-DTPA, measuring the signal intensity of the region of interest. After ATN-10 administration, the 9L glioma model showed early (5 min) and delayed (24 hr-) peak enhancement whereas the cold injury model showed only early enhancement and the 24-hour MCA occlusion model did not show significant enhancement. After Gd-DTPA administration, all three models showed similar pattern of only early enhancement. As a contrast agent for MR imaging, ATN-10 showed different behavior than Gd-DTPA in demonstrating the blood-brain barrier disruption and moreover ATN-10 showed selective enhancement in experimental brain tumors.
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PMID:Tumor specific contrast enhancement study of Mn-metalloporphyrin (ATN-10)--comparison of rat brain tumor model, cytotoxic and vasogenic edema models. 941 11

The incidence of acute tubular necrosis ATN after cadaveric kidney transplantation in our centre has been in the range of 50%. A prospective study was carried out in 1991 and 1992 to assess the effect of in situ perfusion and hypothermic storage of kidneys harvested from brain-dead haemodynamically stable and unstable donors. Three litres of Ringer's solution were used for in situ perfusion. In 40 cases, the kidneys were stored in Euro-Collins (EC) solution and in the other 78 cases, in University of Wisconsin (UW) solution. Among the factors that could contribute to ATN, we analysed warm ischaemia time, anastomosis time and cold storage time. Function was considered to be delayed if the patient required posttransplantation dialysis. The donors were considered haemodynamically unstable when hypotension before harvesting was present (BP < 70 mm Hg over 2 h) despite high doses (> 15 microg/kg per minute) of dopamine or when cardiac arrest occurred at the time of harvesting and oliguria had been present for at least 2 h. Haemodynamically stable donors with a BP greater than 80 mm Hg had a normal diuresis. In all donors in this group the dose of dopamine was lower than 10 microg/kg per minute. The study showed that storage in UW solution did not influence the incidence of ATN in kidneys harvested from haemodynamically unstable donors. Differences observed in our study were due to haemodynamic status preceding donor nephrectomy and length of cold storage time.
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PMID:In situ perfusion and UW solution used for storage did not decrease the incidence of ATN in kidneys harvested from hemodynamically unstable donors. 1127 Dec 84


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