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)

CsA-Pred therapy yields equivalently good patient survival for LRD and 2 degrees CAD versus 1 degree CAD transplants. There is a long-term graft survival advantage for LRD versus 1 degree CAD transplants (5 years; 83% vs 58%). 2 degrees CAD transplants have inferior graft survival when compared with 1 degree CAD grafts (one year; 78% vs 67%). Multiple donor factors adversely affecting graft outcome include increased warm and cold ischemia times, pulsatile perfusion, use of pressors or diuretics in the donor, donor age less than 10 years, donor blood transfusions, and kidneys shipped from other centers. Recipient factors adversely affecting graft outcome include retransplantation and CMV infection as well as noncompliance with therapy. HLA-matching and pretransplant blood transfusions have not contributed in a statistically significant way to graft outcome although they may affect the quality of graft function at this center. Immunosuppressive therapy with CsA-Pred must be tailored to the individual patient. Continuous IV CsA infusion in the preoperative period and slow steroid taper impact favorably on graft outcome. The complications of CsA therapy include neuroectodermal toxicity, hepatotoxicity, and most importantly, nephrotoxicity. Other problems unique to CsA-Pred therapy include hypertension, delayed graft thrombosis, and de novo hemolytic uremic syndrome. Hepatotoxicity may eventuate in biliary and pancreatic complications necessitating surgical therapy. The overall incidence of infection and neoplasm remains low with CsA-Pred therapy. The use of therapeutic trough CsA level monitoring, as well as pharmacokinetic and pharmacodynamic analyses may assist in clinical decision making regarding administered doses, dosing interval, and discrimination between rejection and nephrotoxicity.
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PMID:Factors determining renal transplant outcome at the University of Texas at Houston. 315 93

We reviewed 14,005 renal grafts with the temporal opportunity for 10-year survival (transplanted 1975 and earlier) and analyzed 10-year actuarial graft survival and the rate of late (3- through 10-year) graft loss as reflected by half-life. The 10-year graft survival for first transplants in HLA-identical siblings was 67% versus 38% for parental donors and 20% for cadaver donors. Factors with substantial influence on 10-year graft survival include transplant number, transfusions (0, 17%; greater than or equal to 1,33%), HLA-A,B mismatches (0, 29%; 1-2, 20%, 3-4, 17%), cold ischemia time (0-3 hours, 32%; 4-6 hours, 27%; 7-12 hours, 21%; greater than 12 hours, 16%), preservation method if CIT is no more than 24 hours (cold storage, 22%; machine, 17%), recipient race (Caucasian, 23%; black, 11%), original disease, recipient age, recipient sex, donor race, and the quality of early graft function (less than or equal to one month). Factors not significantly influencing 10-year graft survival were panel-reactive antibodies, warm ischemia time, preservation method if CIT was more than 24 hours, and donor sex.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Factors important in 10-year kidney transplant survival. 315 94

1. Clinical data on 6632 first cadaver transplants performed since January 1983 were analyzed by multivariate (Cox regression) and univariate (life-table) methods. 2. Cox regression analysis showed blood transfusion, recipient's race, HLA mismatch, highest antibody, warm ischemia time, and cyclosporine treatment as significant factors affecting graft survival. 3. A comparison of survival curves predicted by Cox regression analysis and that by the life-table method showed close agreement between the two methods. 4. Cyclosporine was one of the most significant variables affecting graft survival. There was a 13% overall increase in one-year graft survival due to cyclosporine treatment. However, other factors were still significant; they have not become obsolete in the cyclosporine era.
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PMID:Univariate and multivariate analyses of cadaver kidney graft survival data. 315 7

1. The risks associated with nonbeneficial matching constitute a persistent hazard to the transplant over a long period. 2. The benefits of HLA matching and CsA are separate and additive. 3. There is no evidence that beneficial matching is not relevant to all (UK) centers. 4. Contemporary typing methods are expected to improve the accuracy of typing and reduce kidney cold-ischemia times. 5. Organ sharing increases the numbers of beneficial matches. 6. Patients with easily matchable ABO-HLA phenotypes should wait for beneficially matched transplants. 7. Patients with phenotypes that are difficult to match should be intelligently mismatched after due consideration of responder status, acceptable mismatches, and cross-reactive groups. 8. Organ sharing does not prejudice graft survival. 9. Wastage is minimized with a central clearing house. 10. Organ sharing reduces the incidence of high sensitization. 11. Organ sharing is cost effective. For these reasons we repudiate the view that organ sharing is now superfluous.
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PMID:In defense of organ sharing in kidney transplantation. 315 14

The salient features of one-year regraft transplant survival are as follows: 1. The effect of cyclosporine is less (about 7% increase in one-year graft survival) on regrafted patients than on first grafts. 2. In general we saw a HLA antigen matching effect in cyclosporine- and noncyclosporine-treated retransplant patients. 3. Patients who received living-related HLA two-haplotype matched kidneys did equally as well as a first or regraft recipient. 4. Transfusions seemed to have a minimal effect on regraft survival. 5. It is more important to match in patients who have PRA and the matching benefits translate into 61% and 75% one-year graft survival for zero DR and zero B,DR mismatched regraft patients, respectively. 6. In regrafts, female donor kidneys resulted in 15% lower one-year graft survival than male donor kidneys. 7. Retransplant patients from fair centers showed a significant 13% increase in one-year graft survival with cyclosporine. 8. Cold ischemia time, diabetes, and kidneys used locally or shipped had little effect on the regraft one-year survival. 9. The initial function of the retransplant kidney had a very large effect on the final one-year graft outcome of that kidney and was independent of the use of cyclosporine patients having a functioning kidney at one month had 75% and 72% one-year regraft survival with and without cyclosporine treatment, respectively. Patients having a nonfunctioning kidney at one month had 5% and 8% one-year regraft survival with and without cyclosporine treatment, respectively. 10. Responder and nonresponder classifications as defined by the duration of the first graft resulted in a 10 to 15% difference in regraft survival. 11. The effect of HLA-A,B matching was very strong in responder patients, i.e., there was a 32% difference in one-year regraft survival between zero mismatch and more than two antigens of mismatch. In nonresponder patients, the effect of HLA-A,B matching was only 5%. For HLA-DR locus matching, the difference was 12% for responders and 6% for nonresponders. 12. Cyclosporine use showed about a 10% increase in graft survival in responders and nonresponders. 13. Responder classification was also possible by separating patients who had initial function but no function at one month (responders) from those with function at one month (nonresponders).
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PMID:Regraft kidney transplant survival. 315 19

1. Transplant centers were grouped according to one-year graft survival rates of first cadaver transplant recipients treated with CsA. Not surprisingly, the major differences among center groups were associated with the success achieved with CsA in both patient and graft survival. Centers with the poorest survival rates were those with the least improvement over azathioprine and prednisone immunosuppression. 2. There was a definite "learning curve" associated with improvements using CsA immunosuppression for excellent and good centers. Fair centers have yet to see a significant improvement in graft survival overall with CsA. 3. Survival rates for living-related transplants varied little among the center groups, suggesting that most centers do equally well with low-risk transplants. 4. Pretransplant risk factors such as HLA matching, sensitization status, age, sex, and race of the recipients, and ischemia times varied little among the center groups. The center effect cannot be explained by recipient demographic risk factors.
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PMID:The center effect. 315 27

1. Kidneys from female donors between the ages of 31 and 50 had consistently poorer graft survival rates than kidneys from male donors or younger female donors. 2. Sensitized first cadaver kidney recipients of older female donor kidneys had a one-year graft survival rate of 65% as compared with 82% in recipients of young male donor grafts (p less than 0.001). Retransplanted recipients of older female donor grafts had a one-year graft survival rate of 48% as compared with 70% in recipients of young male donor kidneys (p less than 0.001). 3. The effects on graft survival of donor age and sex were considerably greater than the effect of cold ischemia in excess of 36 hours. 4. The cause of donor death was a risk factor for sensitized and regraft recipients. In data from 45 transplant centers, sensitized first transplant recipients of nontrauma donor kidneys had a one-year graft survival rate of 67% versus 78% (p = NS) for recipients of trauma donor kidneys. Regraft recipients of nontrauma donor grafts had a one-year graft survival rate of 55% versus 67% (p less than 0.05) for recipients of trauma donor kidneys. 5. The cause of donor death effect and the effects of donor age and sex may be related as older female donors accounted for 37% of nontrauma donors and only 7% of trauma donors were older females. 6. A surprisingly high percentage of older female (6%) and nontrauma donor kidneys (3%) failed on the first day posttransplant in regrafted patients. A very sensitive crossmatch may help reduce the number of immediate failures. 7. HLA matching improved graft survival of female donor kidneys to a greater extent than male donor kidneys in regrafted patients. With zero or one mismatch at HLA-B,DR there was no difference in one-year graft survival between male and female donor kidneys. In first cadaver transplants, the difference in graft survival between older female and young male donor grafts was minimized by very good matching. Matching also abrogated the donor sex and age effects in living-related donor transplants. 8. Sensitized patients and patients who have previously rejected a kidney should be given priority for young male trauma donor organs when these become available.
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PMID:Donor factors. 315 42

1. In this prospective study of 613 CD and 205 one haplotype mismatched LRD transplant recipients treated with CyA, there was no influence of HLA-matching (A, B, DR or combinations) on graft survival rate at one and two years. 2. Patients who successfully received HLA-DR-matched kidneys (CD or LRD) had fewer rejection episodes during the first six months after transplantation. 3. Three factors significantly reduced the cadaveric graft survival rate: (a) presence of panel reactive T-cell antibodies in a current recipient serum, (b) cold ischemia time beyond 27 hours, and (c) recipient age above 55 years. 4. The survival rate of one haplotype mismatched LRD kidneys was excellent and is considered to be the optimal treatment for uremia also in CyA-treated patients. 5. Based on this study, exchange of well HLA-matched CD kidneys to non-sensitized patients has been terminated provisionally in Scandia-transplant. Exchange of HLA-A, B-matched kidneys will be maintained, however, for sensitized patients inasmuch as this will increase the chance of obtaining a negative cross-match and possibly improve graft survival in this high-risk patient group.
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PMID:HLA-matching in cyclosporine treated renal transplant recipients: a prospective Swedish-Norwegian multicenter study. 315 55

1. In transplants performed between 1971 and 1986, first cadaver donor grafts had a half-life ranging from 6.6 to 7.5 years in the period after the first year. Second cadaver donor grafts had a half-life of 5.1 to 6.5 years. Parental donor grafts had a half-life of 9.3 to 11.8 years, whereas HLA identical sibling donor transplants had a half-life of 19.1 to 26.5 years. Siblings with no haplotype in common had an average half-life of 8.7 years. 2. Between 1971 and 1984, white recipients had an average half-life of 7.7 years, which increased to 9.3 years in 1985-1986. Black recipients' half-life decreased from 5.4 years in 1975-1976 to 3.5 years in 1985-1986. The reason for this decrease is not apparent. 3. The half-life of transplants of different recipient ages did not vary significantly. The average half-life during this period of study was 7.4 years for those younger than 21 years of age, 8.2 years for recipients 21 to 50 and 6.7 years for those older than 50. 4. In the early data, there was some evidence that the half-life of kidneys with cold ischemia below 13 hours was superior. However, in the latest period (between 1983 and 1986) the average half-life was 7.6 years for CIT below 13 hours, 7.2 years for those with 13 to 24 hours and 6.4 years for more than 24 hours. 5. For patients receiving kidneys with no HLA-A,B mismatches, the average half-life was 10.1 years. Those with A,B mismatches had a half-life of 6.7 years, and for those with no A,B antigens in common, the average half-life was 6 years. 6. In the period after 1981, the average half-life of patients with no A,B,DR mismatches was 9.1 years compared with 6.5 years for those with A,B,DR mismatches and 5.4 years for those with no A,B,DR antigens in common.
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PMID:Long-term survival. 315 79

Whether kidneys from cadaver donors should be exchanged among transplant centers is controversial. We analyzed the effect of matching for HLA-B and HLA-DR antigens on graft survival in patients treated with cyclosporine. The results in 9369 recipients of kidneys obtained and transplanted in the same center were compared with those in 5553 recipients of kidneys shipped from one center to another. In both patient subgroups, the association of HLA matching with graft survival was statistically significant (P less than 0.0001). Moreover, well-matched exchanged kidneys survived better than poorly matched locally transplanted kidneys. Among patients receiving their first cadaver transplant, graft survival at one year was 13 percentage points higher (P less than 0.0001) in exchanged kidneys without mismatches than in local kidneys with four mismatches. Among patients receiving their second transplant, graft survival was 21 percentage points higher (P less than 0.001). Kidney preservation for up to 48 hours did not affect graft survival significantly. Transplantation of poorly matched local kidneys preserved with a short period of cold ischemia (less than 24 hours) had significantly lower rates of success than did transplantation of well-matched exchanged kidneys with a longer period of cold ischemia (up to 48 hours) (P less than 0.0001). Our data indicate that the exchange of cadaver kidneys among transplant centers to obtain grafts with better HLA matching can improve the success rate of renal transplantation.
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PMID:The benefit of exchanging donor kidneys among transplant centers. 328 57


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