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

Portal-enteric (PE) transplantation of the pancreas allograft provides maintained physiologic drainage, and theoretically the portal delivery of transplantation antigens may have beneficial effects on the graft acceptance leading to improved graft survival. To determine whether the technique of pancreas placement affects the incidence of acute rejection we reviewed our experience in technically successful PE and systemic-bladder (SB) drained simultaneous pancreas and kidney (SPK) transplants performed between 1989 and 1994. Forty-seven recipients were included (SB = 30, PE = 17). All patients received cyclosporine based quadruple immunosuppression and survived at least 1 month. The two groups were comparable in HLA mismatches, cold ischemia time and level of immunosuppression at time of rejection. In the SB group the incidence of rejection was 1.04 kidney rejection/patient and 0.90 pancreas rejection/patient whereas the PE group experienced 0.53 kidney rejection/patient and 0.47 pancreas rejection/patient. The two groups were compared using incidence density statistics due to great variation in follow-up time. The SB group had a significant higher density of both kidney and pancreas rejections (p < or = 0.037 for kidney rejection and 0.058 for pancreas rejection). In addition, while 6 of 30 (20%) pancreas grafts and 4 of 30 (13%) kidney grafts were lost to irreversible rejection in the SB group, only 1 of 17 (6%) pancreas graft and 1 of 17 (6%) kidney graft were lost in the PE group. These data demonstrate, that the PE placement of pancreas allograft affects the rates of acute rejection and graft loss, and imply that there exist some important immunological advantages when the pancreas graft is drained into the portal circulation.
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PMID:Patterns of acute rejection in portal-enteric versus systemic-bladder pancreas-kidney transplantation. 964 7

The purpose of this investigation was to compare outcomes in the immediate posttransplant period for hemodialysis (HD) and peritoneal (PD) dialysis patients who received cadaveric renal transplantation. Data were obtained from the United Network of Organ Sharing on all cadaveric graft recipients who were dialysis-dependent at the time of transplantation between April 1994 and December 1995. Baseline characteristics were compared between groups, and multivariate logistic regression was performed with outcome measures including urine production in the first 24 h posttransplantation (U24), requirement for dialysis in the first week posttransplant (FWDIAL), and treatment for acute rejection during the initial hospitalization. The odds of oliguria (not producing urine in the first 24 h) were 1.49 (1.28 to 1.74) times higher in HD versus PD patients. After adjustment for other comorbid conditions including age, gender, race, HLA mismatch, time on dialysis, panel-reactive antibodies, and cold and warm ischemia time, the odds of oliguria were 1.60 (1.14 to 2.25) times higher in black HD patients compared with PD patients and 1.29 (1.06 to 1.57) times higher in white HD patients. In a similar manner, after adjustment for significant comorbid conditions, the odds of requiring dialysis in the first week were 1.56 (1.22 to 2.0) times higher in black HD patients versus PD patients and 1.40 (1.21 to 1.60) times higher in white HD patients. The rate of acute rejection was similar during the first hospitalization. These results suggest that there is an association between hemodialysis and delayed graft function. Differences in biocompatibility between the two modalities could potentially be responsible.
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PMID:Dialysis modality and delayed graft function after cadaveric renal transplantation. 989 Mar 21

We followed up a cohort of 680 renal transplant recipients receiving cyclosporine (CsA) immunosuppression with the aim of establishing an early-risk profile for early and late hypertension (HT) after renal transplantation (RTx), specifically comparing the predictive role of immunologic and nonimmunologic markers of graft prognosis. HT was defined as the need for antihypertensive drugs. The prevalence of HT was 65% at the time of RTx, increased to a peak of 78% at the end of the first year, and stabilized between 71% and 73% thereafter. Multivariate analysis identified HT at the time of RTx, basal renal disease, and grafting the right kidney as independent predictors of HT 3 months after RTx. The risk profile for HT 12 months after RTx included HT present at RTx, grafting the right kidney, markers of early ischemia-reperfusion injury (delayed graft function, cold and warm ischemia), and transplant from an elderly or female donor. Polytransfusion before RTx was associated with a decreased risk for HT, but retransplantation, increased reactivity against the lymphocyte panel, poor HLA compatibility, and early acute rejection did not portend an increased risk for the complication under study. The CsA schedule (dose, trough levels) correlated poorly with the blood pressure status of the patients, but simultaneous graft function was independently associated with late HT. In conclusion, the early predictive profile for HT after RTx includes, preferentially, nonimmunologic markers of graft prognosis. Hyperfiltration damage may be a significant pathogenic mechanism for this complication of RTx.
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PMID:Early immunologic and nonimmunologic predictors of arterial hypertension after renal transplantation. 991 63

Aside from HLA identical sibling donors, spousal donor transplants are the best living donors because their 3-year graft survival is comparable to that of all other living donors--with the exception of HLA identical siblings. Interestingly, the 14.5 year half-life of spousal donor kidneys was superior to the 10.8 year half-life of other living donor transplants. Better quality kidneys is the principal explanation for higher spousal donor graft survival rates when compared with cadaver donors. This was evident from the 2% anuria rate in the first post-operative day for spouse donor compared with 10% of cadaver donor transplants. Moreover, the requirement for dialysis was 6% for spouse donor grafts compared with 22% of cadaver donor transplants. The damage is not attributable to cold ischemia time but rather to agonal events and shock prior to kidney harvesting. In a survey of 176 spousal renal transplant donors, 175 of 176 said they would advise others to donate a kidney to a spouse--and only one donor advised against it. Of the "yes" responses, 28% provided additional comments enthusiastically recommending it. About 47% reported improvements in the marital relationship, 29% in the sexual relationship, and 25% described improved relations with their children. The fact that the donor reaps many direct personal benefits should make spousal donation the first consideration for living-donation (after the HLA-identical sibling donor).
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PMID:Spousal and other living renal donor transplants. 991 11

Delayed graft function (DGF) has been identified as a predictor of poor long-term graft survival, but whether its effects are independent of rejection or final serum creatinine level is controversial. Based on the results of 57,025 first cadaver transplants reported to the UNOS Registry, we showed that: 1. Early acute rejection significantly lowered one-year graft survival rates by 8-9% in kidneys with early function (EF) (89% vs 80%; p < 0.001) or with DGF (72% vs 64%; p < 0.001). 2. DGF significantly lowered short- and long-term graft survival in patients without rejection (EF-1-yr graft survival rate of 89%, t1/2 of 9.5 years vs DGF-72% 1-yr graft survival rate, t1/2 of 6.7 years; p < 0.001). 3. Even when the discharge serum creatinine level was < 2.0 mg/dl with no rejection, DGF lowered graft survival (EF-1-yr graft survival rate of 93%, t1/2 of 10.4 years vs DGF-90% 1-yr graft survival rate, t1/2 of 7.6 years; p < 0.001). 4. Acute rejection, elevated discharge serum creatinine level (2-6 mg/dl) and older donor age (46-60 yrs) each lowered one-year graft survival rates in a stepwise fashion. There was exceptionally poor graft survival of kidneys from donors aged 46-60 with DGF, whether or not early acute rejection was present (with rejection-1-yr graft survival rate of 61%, t1/2 of 5.6 yrs vs no rejection-1-yr graft survival rate of 71%, t1/2 of 5.3 yrs). 5. Increasing cold ischemia time only decreased graft survival when there was no DGF and no rejection and had no significant effect on long-term graft survival. 6. Among recipients of HLA-matched cadaver kidneys, DGF lowered short- and long-term graft survival, even in the absence of early rejection (EF-1-yr graft survival rate of 93%, t1/2 of 14.8 yrs vs DGF-1-yr graft survival rate of 76%, t1/2 of 7.8 yrs). 7. DGF was associated with higher rates of acute rejection but impaired long-term graft survival even when rejection was absent and discharge creatinine was normal. These data support the hypothesis that DGF leads to an injury response that can reduce graft survival through antigen dependent and antigen independent mechanisms.
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PMID:Effect of delayed graft function on short- and long-term kidney graft survival. 991 13

In a case-control study performed in two centers, the incidence of delayed graft function (DGF), defined as the necessity to perform dialysis after transplantation, was analyzed according to prior treatment with continuous ambulatory peritoneal dialysis (CAPD; n = 117) or hemodialysis (HD; n = 117). The patients were matched for age, sex, HLA compatibility, and cold ischemia time. The patients were followed up for 6 months to monitor renal graft function (serum creatinine [Screa] level immediately after transplantation, at 6 weeks, at 6 months) and postoperative complications. No significant differences were found in the warm ischemia time of the graft or previous time on dialysis. DGF occurred in 27 CAPD patients (23.1%) and 59 HD patients (50.4%; P < 0.0001). The decline in Screa level after transplantation was faster in CAPD patients: the time for Screa level to decrease 50% after transplantation (T1/2Screa) was reached after 5.0 +/- 6.6 days in the CAPD group compared with 9.8 +/- 11.5 days in the HD group (P < 0.0001). A greater number of patients developed acute rejection episodes in the CAPD group (P < 0. 05), but Screa level was not different in the two groups 6 weeks and 6 months after transplantation. No differences were observed in infectious or surgical complications. This study shows that immediate renal function after transplantation is better in CAPD patients and that peritoneal dialysis should be considered as a first choice for pretransplantation therapeutic modality.
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PMID:Reduced incidence of acute renal graft failure in patients treated with peritoneal dialysis compared with hemodialysis. 1021 52

Chronic rejection remains the single most important cause of renal allograft loss after the first year post-transplant. We performed a matched case control study within our cohort of 471 renal allograft recipients, comparing 66 patients with histologically proven chronic rejection with 66 controls. Analysis of immunological (transfusion, sensitisation, HLA matching, number of transplantation, number of acute rejections (AR), immunosuppression) and non-immunological (donors and recipients age and sex, CMV disease, post-transplant acute tubular necrosis, cold ischemia) factors which could predict the occurrence of chronic rejection (CR) was performed, using Wilcoxon rank test, Mac Nemar test and Cox model. Univariate analysis showed that potential risk factors for CR are: donor age > 45 years (p = 0.05), recipient age < 40 years (p = 0.008), CMV disease (p = 0.03), number of acute rejection episodes (p = 0.009), retransplantation (p = 0.002). Multivariate analysis showed that only the following factors significantly increased the risk of CR: AR episodes (p = 0.01) with an odds-ratio at 3.5 (95% CI = 1.3-3.9) for the second acute rejection episode and at 6.5 (95% CI = 1.5-29.4) for the third acute rejection episode, donor age > 45 years (p = 0.03) with an odds-ratio at 3.5 (95% CI = 1.1-10.6). Our data suggest that better matching at donor recipient age and more potent immunosuppressive protocols resulting in no acute rejection may improve the long term graft survival. They also show that the use of old donors (> 45 years), as a response to organ shortage is detrimental for long term renal function.
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PMID:[Risk factors of chronic rejection in kidney transplantation, results of a single center study]. 1041 5

A 37-year-old woman with psoriasis arthropathica associated with aortic regurgitation underwent replacement of her aortic valve. The serum rheumatic factor was negative. HLA-B 27 was demonstrated in HLA analysis. She experienced a sudden onset of dyspnea and cardiac arrest in the hospital. She was hospitalized and found to have severe aortic regurgitation. She had her aortic valve replaced. We paid attention to management of blood pressure not to trigger cardiac ischemia and of skin lesion not to trigger infection and the worsening of skin condition. There are few reports of HLA-B 27 positive psoriasis arthropathica accompanied by aortic regurgitation. However, the present case may suggest that the cardiac study may be required for HLA-B 27 positive psoriasis arthropathica.
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PMID:[Anesthetic management of a patient with psoriasis arthropathica]. 1043 24

Based on analyses of kidney transplants reported to the UNOS Scientific Renal Transplant Registry from 1991-1997: 1. The 5-year patient and graft survival rates were 82% and 63%, respectively, for 50,291 recipients of cadaver donor kidneys and 90% and 77%, respectively, for 20,258 recipients of living donor transplants. 2. Black recipients had 12% lower 5-year graft survival rates than Whites whether the kidney was from a cadaver donor (n = 11,575) or a living donor (n = 2,806). 3. The survival rates of second transplants were only 2% less than first transplants, whether the kidney was from a living or cadaver donor. The one-year regraft survival rates for multiply retransplanted patients were 77% and 87% for cadaver and living donor retransplants, respectively. 4. Graft survival rates were 5-6% lower among broadly sensitized recipients (> 50% PRA) than unsensitized (< 10% PRA) recipients, regardless of the donor source. 5. The average recipient aged between 1991-1997. The mean age increased from 42-46 years for cadaver kidney and from 34-40 years for living donor transplant recipients. 6. The percentage of older donors also increased during 1991-1997. The proportion of cadaver kidneys from donors over age 45 rose from 24% in 1991 to 33% in 1997. The percentage of living donors over age 45 increased from 23% in 1991 to 29% in 1997. 7. There was a 25% difference in 5-year graft survival rates comparing recipients of kidneys from 19-30 year-old cadaver donors with those who received kidneys from donors over age 60. Recipients of kidneys from living donors over age 60 had an 8% lower 5-year graft survival rate than when the donor was aged 19-30. 8. Among recipients of cadaver kidneys, the incidence of delayed graft function increased from 17% when the donor was aged 15-20 to 40% when the donor was over 65. DGF reduced one-year survival rates by 10% and half-lives by 2 years when grafts from 19-30 year old donors and donors older than 55 were analyzed separately. Cold ischemia time also resulted in increased DGF, from 17-39% for CIT up to 49-72 hours. However, when the donor was aged 19-30, DGF ranged from 12-30% and when the donor was over 60, DGF increased from 33-68% with longer CIT. 9. Rejection episodes before the initial hospital discharge resulted in a 10% reduction in 5-year graft survival rates regardless of the donor source. 10. The degree of HLA compatibility between the donor and recipient was associated with a 12% difference in 5-year graft survival rates among recipients of cadaver kidneys. The survival difference was 11% among recipients of living-related donor kidneys, but there was no difference in the survival of one- and 2-haplotype disparate grafts. Similarly kidneys transplanted from distant relatives and from unrelated donors with poor HLA compatibility resulted in survival rates that were not distinguishable from HLA-mismatched related donor kidneys.
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PMID:The UNOS Scientific Renal Transplant Registry. 1050 82

The occurrence of acute cellular rejection after orthotopic liver transplantation is common. At present, no allowance is made in immunosuppressive regimens for parameters other than weight. We investigated parameters in 121 consecutive patients receiving their primary allograft to determine if there are pretransplantation factors predicting the occurrence of acute cellular rejection after transplantation. The case notes and dietetic notes of these patients were reviewed for age at transplantation, cause of liver disease, preoperative albumin and creatinine levels, lymphocyte count, anthropometric measurements, donor age, HLA DR mismatch, and cold ischemia time. Acute cellular rejection was more likely to occur in younger patients, patients with Child's class A disease, and those with normal midarm muscle circumference. Acute rejection was increased in transplant recipients from donors aged younger than 30 and older than 50 years. Acute cellular rejection was less likely to occur in patients who underwent transplantation for alcoholic liver disease. Chronic rejection was significantly increased in women and those patients who experienced recurrent acute rejection. On multivariate analysis, the only significant predictor was the decreased likelihood of acute rejection in patients with depleted midarm muscle circumference. In conclusion, it may be possible to individualize immunosuppressive regimens on the basis of pretransplantation characteristics.
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PMID:The prediction of acute cellular rejection in orthotopic liver transplantation. 1054 33


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