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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A statistical method which accounts for the heterogeneity of clinical materials is presented and applied to a material of necrokidney transplantations. It is concluded that the recipient sex and the period in which the transplantation was performed are the most important factors (best prognosis for female recipients, best programs for transplantations in the first periods) and that the HLA-match grade has a significant influence on graft survival for male recipients and transplantations with short cold ischemia time. The present analysis has furthermore demonstrate the heterogeneity of the material as judged by the associations between factors and the overestimation of the influence of some of the factors by direct comparisons.
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PMID:The influence of 13 clinical and immunological factors on renal graft survival: a contingency table analysis. 35 1

To determine whether perfusion preservation affected the structure and survival of kidney transplants, we correlated clinical and histologic data in 77 kidneys biopsied one hour after transplantation. Twenty-one of 36 perfusion-preserved kidneys had a glomerular capillary lesion suggestive of intravascular coagulation. None of 41 kidneys preserved by hypothermia alone had this lesion. Presence of the lesion did not correlate with donor or recipient characteristics, warm or cold ischemia time, HLA match, percentage of preformed lymphocytotoxic antibody titers or perfusion characteristics. Of 21 transplants with the lesion, nine required nephrectomy by one month, and one-month serum creatinine was less than 2.0 mg per deciliter in only three of the remaining 12 transplants. We conclude that perfusion preservation may cause pathologic changes that may adversely affect kidney-transplant function. The causes of the pathologic process remain unclear.
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PMID:Perfusion nephropathy in human transplants. 79 Jan 84

1. One-year graft survival rates were 80%, 74%, and 66% for recipients of first (27,755), second (4,263), and multiple (914) cadaveric renal transplants, respectively. The 1-year patient survival rate was 94% for recipients of first or second grafts and 92% for multiply retransplanted patients. Half-lives projected for all cadaver transplants surviving the first year were approximately 8 years. 2. One-year graft survival rates were 95% for recipients of HLA-identical sibling-donor transplants (1,493), 91%, 90%, and 89% for recipients of 1-haplotype-matched sibling (1,787), parent (2,118), and offspring (715) donor grafts, respectively. One-year patient survival was 94% for parents receiving transplants from their children and 98% for all other recipients of kidneys from immediate family members. Projected half-lives were 26 years for HLA-identical grafts and 12-14 years for 1-haplotype-mismatched transplants from living related donors. 3. There were 181 transplants between spouses, with a 1-year graft survival rate of 92% and 99% patient survival. There were also 369 transplants from distant relatives or unrelated living donors with a 1-year graft survival rate of 86% and 95% patient survival. Projected half-lives for these transplants were 13 years. 4. Rejection episodes that occurred during the initial transplant hospitalization were reported in 24% of first and 33% of retransplanted recipients (p < 0.001). Rejection-free patients had an 85% 1-year graft survival rate compared with 67% and 58% in recipients of first or regrafts after early rejection (p < 0.001). Rejection episodes were strongly associated with histoincompatibilities. Among HLA-identical sibling transplants, 6% had early rejection compared with 12% of HLA-A,B,DR-matched cadaver transplants, 25% of parent-donor transplants and 28% of HLA-DR-mismatched cadaveric transplants. 5. The serum creatinine level (SCr) reported at the time of discharge was predictive of graft survival in both the short and long term. Recipients of first cadaver transplants discharged with SCr below 1.6 mg/dl (8,960) had a 91% 1-year graft survival rate and a projected half-life of 12 years, while those with SCr above 3.5 mg/dl had 49% 1-year graft survival and 5.3-year projected half-life (p < 0.001). Discharge SCr was significantly influenced by the recipient's weight, the donor's age, and the cold ischemia time.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The UNOS Scientific Renal Transplant Registry. 130 88

1. There were no significant differences in 1-year graft survival rates comparing kidneys stored with 3 commonly used cold storage solutions (Collins', EuroCollins, and University of Wisconsin) over the past 12 years, even though preferences have changed sharply. 2. No significant differences in 1-year graft survival rates were noted when comparing kidneys preserved by pump perfusion and those maintained by simple cold storage. The lower incidence of delayed graft function for pump-preserved kidneys was at least partly attributable to a center effect. 3. Prolonged cold ischemia time (CIT) was associated with an increase in delayed onset of function. Of 2,718 kidneys transplanted within 24 hours, 21% did not function well within the first week. The fraction increased to 28% and 33% of kidneys transplanted between 25 and 36 hours (n = 1,858) and after 36 hours (n = 955), respectively (p < 0.01). One-year graft survival rates were 82%, 78%, and 76% for kidneys transplanted within 24 hours, between 25 and 36 hours, and after 36 hours, respectively (p < 0.01, each comparison). 4. HLA matching neutralized the impact of prolonged CIT completely. One-year graft survival was more than 86% in 715 recipients of 0 HLA-mismatched kidneys, regardless of CIT. For recipients of mismatched transplants, survival decreased by 5-6% as CIT increased from less than 24 to more than 36 hours (p < 0.01). Of the mis-matched kidneys with less than 24 hours CIT, up to 83% survived at 1 year compared with 87% of matched kidneys with more than 36 hours CIT (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Preservation. 130 14

A randomized, prospective comparison of OKT3 vs. ALG (University of Minnesota) was performed in patients who had acute renal failure after a cadaver renal transplantation. Criteria for admission to the study were oliguria or increasing serum creatinine in the first 12 hr after renal transplantation. ALG or OKT3 was administered after randomization beginning 12-36 hours posttransplantation. There were no significant differences in age, sex, original disease, ischemia time, or HLA matching between groups. Graft survivals at 1 and 6 months were 84% and 84%, respectively for the ALG group. One- and 6-month graft survival for the OKT3 group was 88% and 84%, respectively. These differences were not statistically significant. The number of rejection episodes and the number of patients with rejection episodes were greater, and the time to first rejection was shorter in the OKT3 group compared with the ALG group, although none of these differences reached statistical significance. There were significantly less side effects in the ALG group compared with the OKT3 group (P less than .05). The greatest reductions in side effects were in fever and hypotension. Patients were monitored with flow cytometry analysis measuring the number of CD2 (T11) and CD3 (T3) cells to adjust the dose of both OKT3 and ALG. Starting doses were 10 mg/kg/day of ALG and 5 mg/day of OKT3. There were no significant differences in the incidence of infections (viral or bacterial) between the two groups. There were no rejection episodes during the prophylactic therapy with either ALG or OKT3. In summary, both ALG and OKT3 provided effective prophylaxis for patients with acute renal failure after renal transplantation. OKT3 was associated with a statistically significant increase in incidence of symptomatic side effects.
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PMID:Comparison of OKT3 with ALG for prophylaxis for patients with acute renal failure after cadaveric renal transplantation. 167 2

The subjects of this study were transplant recipients entered in the UCLA Registry file since 1984 and in the UNOS Registry since 1987. [table: see text] 5. Based on the data above, we conclude that the near 20% loss rate in the first year can be roughly allocated as follows: death 3%, technical 3%, agonal kidney damage 6%, and histocompatibility differences 7%. 6. The quality of HLA typing was assessed by examining the frequencies of the various specificities reported for cadaver donors in 8 yearly periods from 1984 to 1991. The A and B loci specificities were remarkably constant. The DR specificities were still undergoing stabilization. 7. No urine output on the first day, which occurred in approximately 10% of the first cadaver-donor transplants, resulted in about a 20 percentage point lower graft survival rate at 1 year. 8. Anuria on the first day increased with cold ischemia time, donor age, cerebral vascular accident donors, and retransplant recipients. 9. Graft survival with anuria on the first day and: [table: see text] 10. When dialysis was required during the first week, there was an approximate 15 percentage point decrease in 1-year graft survival in 25% of the patients. 11. One rejection in the first hospitalization period resulted in 67% 1-year graft survival. More than 1 rejection led to 57% 1-year graft survival. 12. Serum creatinine at discharge was an accurate indicator of subsequent graft survival. Approximately a 7 percentage point drop in 1-year graft survival was noted with each unit of serum creatinine above 2.0 mg/dl.
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PMID:UCLA and UNOS Registries. Overview. 182 Jan 31

Parameters of early failure in kidney transplantation have been analyzed from 507 transplantations with transplant loss in the first month, selected among the 7541 cadaveric kidney transplantations performed in France between 1985 and 1989. These failures represent 6.7 percent of the population transplanted over this period of time, 68.6 percent of the failures that occurred in the first 3 months post-grafting, and 47 percent of the total number of the first year failures. Comparing patients with and without transplant failure in the first month, sex of the donor and the recipient, ABO group of the donor and the recipient, origin of the kidney, cold ischemia time, HLA compatibility, dialysis duration, number of previous transplantations, showed no influence on the occurrence of early failure. Three parameters appeared to be significant risk factors: donor's age less than 5 years, P = 0.00001; recipient's age less than 5 years, P = 0.05; pregraft immunization, P = 0.002. Furthermore, multifactorial analysis showed that the absence of HLA compatibilities between donor and recipient in hyperimmunized patients also has a significant influence on early graft loss. However, comparison of these same parameters in patients with transplant failure within the first month and between 2 and 12 months post-grafting revealed that the influence of these 4 significant parameters is longstanding and that none of them is specific of the precocity of graft loss.
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PMID:[Early failure in kidney transplantation]. 183 3

From January 1984 to January 1989, 139 kidneys were retrieved from 74 brain dead donors in our institution. The transplantation was performed either locally (79), or in an other French institution (40). The five year actuarial survival rate, for the 139 kidneys retrieved in Montpellier, was 65 percent. Many factors about the donor, the retrieval and the recipient, which may affect the graft survival, were entered in a Cox multivariate analysis. The minimal follow up duration was 18 months. The risk factors studied included: donor parameters (age, sex, cause of death, haemodynamic parameters and renal function); retrieval parameters (kidney alone or multiorgan harvesting, discoloration and renal perfusion quality); organ characteristics (multiple arteries and cold ischemia time); recipients parameters (age, sex, prior transplantation, local transplantation or not, and HLA matching). A first multivariate analysis included only pretransplant risk factors. The risk factors for graft loss, as identified by the Cox model, were in the order: donor's age (P = 0.03), arterial pressure (P = 0.01), prior transplantation of the recipient (P = 0.01) and kidney discoloration quality during the retrieval (P = 0.008). Early post transplant parameters were included within this Cox model (poor early renal function, need for dialysis, serum creatinine level at one week). The need for dialysis therefore was identified as the main predictive value (P = 0.002). The 4 other risk factors, selectioned in the first model, always remained significant.
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PMID:[Prognostic factors of success in renal transplantation]. 183 5

Calcium channel blockers (CCB) administered to recipients of cadaveric renal transplants have been shown to improve graft function, decrease the incidence of delayed function, prevent acute cyclosporine toxicity, and lessen the number of rejection episodes in the first several weeks posttransplant. In order to determine whether CCB provide a similar long-term benefit, a retrospective analysis of 83 first cadaveric renal transplants performed in 1987 and 1988 was performed. The clinical course of 17 patients who were discharged and maintained on CCB therapy for 1 year was compared with that of 24 patients who never received CCB during the same 1-year period. The remaining 42 patients were excluded for failing to meet these inclusion criteria. The two groups were similar with respect to age, sex, cold ischemia time, degree of sensitization, HLA matching, DR matching, and DR mismatching. The no CCB group did receive a significantly greater number of pretransplant transfusions. In the 1 year of follow-up, graft loss in the CCB group was less than in the no CCB group (1/17, 5.9% vs. 6/24, 25%). There was a striking decrease in the percentage of first rejection episodes in the CCB group as compared with no CCB therapy (35% vs. 83%, P less than 0.005). In addition, a similar decrease in second rejection episodes was found in the CCB group (18% vs. 33%, P less than 0.05). The two groups also were compared with respect to graft function. Despite similar serum creatinine levels at 1 month (CCB 1.8 mg% vs. no CCB 2.2 mg%, P = 0.37) and 1 year (CCB 1.7 mg% vs. no CCB 2.4 mg%, P = 0.19), the CCB group had a significantly higher glomerular filtration rate at 1 month (53.9 vs. 38.7, P less than 0.05) and 1 year (57.0 vs. 35.0, P less than 0.001) as measured by clearance of radiolabeled iothalamate. These results suggest that the short-term improvements noted in both graft function and rejection episodes with CCB are maintained for the first year posttransplant. More importantly, CCB use results in improved 1-year graft survival.
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PMID:Improved outcome of cadaveric renal transplantation due to calcium channel blockers. 192 43

The outcome of renal transplantation in CAPD patients is still controversial since age and clinical differences often make comparison with hemodialysis patients difficult. The aim of this study was to analyse two homogeneous groups of patients, on CAPD and on hemodialysis. 18 CAPD (Group A) and 18 hemodialysis patients (Group B) were selected for a case-control analysis, matched for age, presence of acute tubular necrosis and Cyclosporine A regimen. Group A and B were not different for male/female ratio, donor age, HLA-Dr mismatches, arterial pressure, cold ischemia, or follow-up. Patient, graft survival and number of rejection episodes did not differ significantly at 1 year; serum creatinine at 6 and 12 months and CyA doses at 1 and 6 months were not different; hospitalization rates for first and subsequent admissions did not differ. Infection-free patients were 9/18 in Group A and 15/18 in Group B, with 12 episodes in Group A and 3 in Group B. Post transplant cholesterol levels showed a trend to increase in both groups and triglycerides levels to a decrease; differences in pre and post transplant in body weight were not significant at 12 months. In conclusion, the outcome of transplantation in CAPD patients is not significantly different from that in hemodialysis patients with similar clinical characteristics.
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PMID:Comparison between two dialytic populations undergoing renal transplantation. 198 44


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