Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cadaveric kidney graft recipients, treated according to a strict, high dose CyA protocol, were followed prospectively for one year. The aim was to study the impact of donor age on transplantation outcome in a homogenously immunosuppressed patient material. The patients were divided into 2 groups; G1: donor age less than or equal to 50 years (mean 34.5 y; range 10-50; n = 49) and G2; donor age greater than 50 years (mean 58.1 y; range 51-68; n = 37). The groups were comparable in terms of recipient age, warm and cold ischemia time, number of HLA A, B, DR mismatches and number of rejection episodes. The result showed no difference in mortality between the 2 groups (12% vs. 13%). One year graft survival was 70% vs. 51% (NS), immediate onset of function was 76% vs. 46% (p less than 0.01), creatinine concentration at one year was 146 +/- 39 vs. 206 +/- 73 mumol/l (p less than 0.05) for G1 and G2, respectively. The most striking finding was a highly significant difference in the rate of graft-related surgical complications, 12% vs. 35% (p less than 0.01) for G1 and G2, respectively. We conclude, that a patient receiving a graft from an elderly donor, runs a higher risk of graft-related complications and that long term graft survival and function also might be influenced by the age of the donor. A possible reason for the inferior results in group 2 might be an increased sensitivity for the toxic effects of CyA of aging kidneys.
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PMID:Influence of the age of cadaveric kidney donors on transplantation outcome and rate of surgical complications. 207 67

One hundred and forty-four patients primarily receiving kidneys from cadaver donors between Jan., 1978 and Oct., 1989, were reviewed. The patients' ages ranged 14-53 with a mean +/- S.D. of 34.7 +/- 8.0 years old. There were 100 males and 44 females. Twenty kidneys were harvested from heart-beating donors and 124 from non-heart-beating donors. In harvest from non-heart-beating donors, we performed in situ cooling through a double balloon catheter placed in the aorta to minimize prolonged warm ischemia. The number of matched HLA A, B antigens was (mean +/- S.D.) 1.7 +/- 0.8 antigens and for HLA DR antigens, it was 1.2 +/- 0.5. One hundred and nineteen of the 144 recipients have had a history of blood transfusion preoperatively. The patients were treated with four different immunosuppressive protocols; regimen I consisting of horse antilymphocyte globulin (ALG), regimen II of large-dose (14 mg/kg/day) of cyclosporin (CsA) and steroid, regimen IIIa of low-dose (4 mg/kg/day) of CsA, steroid and a short course of ALG (500 mg/day) and regimen IIIb of low-dose (6 mg/kg/day) of CsA, steroid and a short course of ALG (1000 mg/day). Fifteen patients received regimen I therapy from Jan., 1978 to Nov., 1982, 49 received regimen II from Nov., 1982 to Dec., 1986, 23 received regimen IIIa from Jan., 1987 to Dec., 1987 and 57 received regimen IIIb from Jan., 1988 to Oct., 1989.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Results of 144 cadaveric kidney transplants]. 228 17

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

Prolonged cold ischemia has been associated with impaired early cadaver renal allograft function. The role of CsA in potentiating these effects is not well understood, but CsA has been implicated in promoting delayed graft function and potentiating renal ischemic injury. In order to establish whether CsA is safely tolerated by kidneys subjected to protracted cold ischemia, we examined patient and graft outcome in a series of 1081 patients receiving cadaver-kidney transplants over an 8-year period (1981-1988). All patients received a standard immunosuppressive regimen that included CsA. Overall actuarial 1-year patient and graft survival rates were 96% and 80%, respectively. Renal preservation was achieved either by pulsatile perfusion (n = 261, 24%) or simple cold storage (n = 820, 76%). Results were analyzed according to total cold ischemic time as follows: 0-23 hr (n = 512; range, 0-23.9 hr); 24-35 hr (n = 380; range, 24.0-35.9 hr); 36-47 hr (n = 161; range, 36.0-47.7 hr); greater than or equal to 48 hr (n = 28; range, 48.0-70.6 hr). These groups did not differ significantly in recipient age, sex, incidence of diabetes, number of pretransplant blood transfusions, level of presensitization, or HLA match. There were no differences in overall actuarial 1-year patient or graft survival rates, incidence of rejection, or renal function at 1 year. There was a higher incidence of impaired early graft function for kidneys preserved greater than or equal to 48 hr, but eventual graft outcome, including serum creatinine at 1 year, was unchanged. Delayed introduction of CsA resulted in improved 1-year graft survival (84.4% vs. 74.7%, P less than 0.05) compared to CsA treatment begun at the time of transplantation ("initial CsA"). This improvement was present regardless of total cold ischemia time. The incidence of permanent graft nonfunction, which has been previously reported to increase with CsA therapy, was influenced by the timing of CsA therapy (initial: 12%; delayed: 3%, P less than 0.05) but was not affected by duration of cold ischemia. Thus, safe preservation of cadaver kidneys for up to 70 h can be achieved by standard techniques even when CsA is incorporated into the immunosuppressive regimen. The most important determinants of graft survival in these patients are the timing of CsA therapy and the presence of early graft function, not the duration of renal preservation.
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PMID:The role of cold ischemia in a provincial organ-sharing program in the cyclosporine era. 230 66

We compare the results in recipients of cadaveric renal allografts immunosuppressed with cyclosporine and prednisone to those who received immunosuppression with cyclosporine, azathioprine and prednisone. The 2 groups were compared relative to HLA-ABDR matching, plasma reactive antibodies, cold ischemia time, diabetes as a cause of renal failure and recipient age greater than 50 years. The incidences of clinical allograft rejection and grafts lost to rejection were not significantly different in these 2 groups evaluated at 1 year. In the 2-drug immunosuppressed group the actual 3, 6 and 12-month graft function was 87, 86 and 85%, respectively, compared to 79, 78 and 74%, respectively, in the 3-drug immunosuppressed group. A difference in graft survival was due to graft loss secondary to vascular thrombosis and patient death, and not to immunological events. No advantage was demonstrated for the use of 3-drug immunosuppression for kidney allografts over a 2-drug protocol of cyclosporine and prednisone.
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PMID:Comparison of 2-drug and 3-drug immunosuppression for cadaveric renal transplantation. 232 2

1. Among patients transplanted in 93 selected centers with good follow-up data, the 10-year graft survival of first cadaver-donor transplants was 18%, parental donor grafts 39%, and HLA-identical sibling donor grafts 66%. The respective half-lives were 6.8, 10.8, and 24.5 years. The donor relationship has been the most important factor in long-term success. 2. Patient half-life for recipients younger than 16 was 36 years; for recipients 16-50 years old it was 17.6 years, and for those over age 50, it was 10.4 years. This marked difference in patient half-lives severely affected functional graft half-lives for the 3 age groups; 6.8, 10.3, and 16.7 years, respectively. However, the differences in patient survival for the 3 age groups were not significantly reflected in graft half-lives that were 6.8, 7.7, and 6.5 years, respectively. Thus, graft loss resulting from rejection was significantly lower in older than in younger patients. 3. Cadaver-donor kidneys with cold ischemia time up to 12 hours and half-lives of 9.1 years in transplants performed before 1975, compared to half-lives of 6.4 years for those with more than 24 hours cold ischemia time. In transplants performed between 1980 and 1983, the half-life of kidneys with cold ischemia time up to 12 hours was 8.7 years, compared to 6.9 years for those with more than 24 hours cold ischemia time. The long-term effect of cold ischemia persists but has diminished in recent years. 4. HLA-A,B loci matching had a significant effect on long-term graft survival. The 10-year graft survival of A,B matched grafts was 30% compared to 18% for 3 or 4 HLA-A,B mismatched transplants. This difference increased at 15 years to 25% in the matched grafts and 10% in the mismatched grafts. 5. A very strong recipient race effect was evidenced by the 24% 10-year graft survival in Whites compared to 10% in Blacks. The half-lives were 8.2 in Whites and 4.8 in Blacks. 6. A listing of 15-year graft survivors has been compiled according to transplantation centers. There was a total of 969 from cadaver donors, 283 from parental donors, and 457 from sibling donors. 7. An analysis of the characteristics of the 15-year graft survivors showed a preponderance of patients with favorable factors, noted in the analysis above. As might be expected, the most striking was the fact that 27% of the 15-year survivors had received kidneys from sibling donors, despite the fact that such donors comprised only 17% of those transplanted in the pre-1975 era.
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PMID:Fifteen-year kidney graft survival. 248

1. Variation among centers accounted for about one-third of the assignable variation in kidney transplant graft survival. 2. Centers varied systematically in their use of CsA and of pretransplant transfusions and in transplant cold ischemia times--factors strongly related to graft outcome. About 90% of patients received CsA. 3. At some centers, graft survival rates in the low 90% range were attained for first transplants from cadaver donors. 4. Variation among centers was less noticeable at high survival rates. Nearly all centers had good results using HLA-identical sibling donors. 5. Centers with better survival rates tended to treat fewer transplants with CsA. There was a modest, but potentially interesting, negative correlation.
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PMID:Center variability. 248 12

1. In the long-term period, the half-life effectively measured loss rate. For HLA-identical sib donors the half-life was 25 years; for parental donors, 13 years; and for cadaver donors, 8 years (now possibly 11 years). 2. HLA-A,B,DR matching exerted the greatest effect on half-life, for a half-life of 17 years was achieved for cadaver donors. This rate was not quite as high as that for A,B,DR matched siblings but was higher than the one haplotype mismatched parental donor transplants. 3. Caucasian recipients had a half-life of 8 years compared to 5 years for black recipients. 4. Excellent centers had a 10-year half-life compared to 5 years for fair centers. 5. Cold ischemia time over 24 hours, recipient age over 55, and donor age of 50-60 had a small effect on the half-life in the order of 1 to 3 years. 6. Among the short-term factors that affect the 1-year graft survival, there was a 12% difference between excellent and fair centers. An 11% difference between A,B,DR matched transplants and 6 A,B,DR mismatched grafts was noted. First-cadaver donor grafts had a 10% higher graft survival at 1-year than second grafts. Other factors together with the difference in 1-year graft survival between the extremes were as follows: sensitization 9%, race 8%, transfusion 6%, donor age 6%, diabetic 3%, recipient age 3% and cold ischemia 1%. Thus more factors affect short-term survival than long-term survival.
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PMID:Long-term survival of kidney grafts. 265 Feb 6

The present analysis of risk factors in human cardiac transplantation is based on a review of 682 endomyocardial biopsies from 52 grafts in 51 recipients. Acute rejection was diagnosed in 149 biopsies (21.8%). The cumulative 1-year graft survival was 91.5 4%. Four out of seven patients died of irreversible rejection. An univariate analysis using the linearized rate of total rejection showed significantly higher frequency of acute rejection when donor and recipient differed for two HLA-DR antigens compared to zero or one HLA antigen disparity (p less than 0.01), as well as in patients treated with low dose steroids, Cyclosporine (CyA) and Azathioprine (p less than 0.01), compared to treatment with CyA high dose steroids. Other risk factors were graft ischemia extending 60 minutes (p less than 0.05) and patient age exceeding 40 years (p less than 0.05). A multivariate analysis using the competing risk hazard model for irreversible (= lethal) rejection was performed. The presence of two HLA-DR mismatches between donor and recipient was found to be an independent risk factor (relative risk = 8.9), and immunosuppression with CyA and high dose steroids without Azathioprine another (relative risk = 15.3). Potential risk factors such as donor and recipient sex, donor age, prior surgery and time on extracorporeal circulation were not of significant prognostic value neither in regard to rejection nor irreversible rejection.
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PMID:Human heart transplantation. Rejection risk factors. 305 17

The factors affecting graft survival in transplant recipients receiving cyclosporin (CsA) are still being debated. Our report is based on an analysis of 202 successive transplantations performed in our institution from May 1984 to December 1986, using low-dose CsA as the basic means of immunosuppression. A total of 142 patients received the triple combination CsA, azathioprine (AZA), and corticosteroids. Sixty patients received a prophylactic combination of CsA, corticosteroids, and antilymphocyte globulins (ALG). From January to December 1986, both regimens were compared in a prospective randomized trial. The factors that affect graft survival were analyzed using the Cox multivariate hazard analysis. The relative risks were calculated for pretransplant baseline risk factors and for outcome-dependent post-transplant risk factors for surviving grafts at 1 month. Transplants performed with a prolonged ischemia time and patients whose graft did not function immediately were statistically at higher risk of graft loss. Adding prophylactic ALG to CsA was associated with better graft survival. Patients who experienced more than 1 rejection crisis and patients whose 1-month CsA dose was lower than or equal to 5 mg/kg per day were also at significantly higher risk of further graft loss. Neither HLA matching, peak panel reactivity, age of the recipient, occurrence of post-transplant renal dysfunction nor 1-month renal function affected the short-term graft outcome.
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PMID:Multiple drug combinations with "low-dose" cyclosporin for renal transplantation. Multivariate analysis of risk factors determining short-term graft survival within one renal transplant center. 307 74


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