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)

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. The realization of the two main goals of the Eurotransplant Organization have been enhanced during the period between 1981 and 1985 by two factors: A reliable HLA-A, -B and -DR typing of kidney donors and recipients, reflected in this analysis by the Hardy-Weinberg analysis but also by the results of the regular tissue typing quality controls. The number of patients who received a kidney without HLA-DR mismatches was 53% (N = 2,904). A significant difference with the 390 of 5,535 (7%) patients who received a kidney with two HLA-DR mismatches. 2. Treatment with cyclosporine increases kidney graft survival significantly in recipients of a first cadaveric transplant which is in agreement with the results of many other groups. Also a significant improvement in kidney graft survival with cyclosporine treatment was observed in recipients of a cadaveric retransplant, an observation in contrast with those of UCLA. 3. Although no significant influence of HLA-A and -B matching was observed in patients treated with or without cyclosporine, the best matched patients had the best graft survival. As stated many times before, the beneficial effect of HLA-A and -B matching is best demonstrated four or five years posttransplantation. 4. The effect of HLA-DR matching on kidney graft survival is highly significant, regardless of whether cyclosporine has been used or not. This finding is also in accordance with those of other investigators. 5. Prolonged cold ischemia periods in cyclosporine-treated patients resulted in a significant decrease of kidney graft survival. This is in contrast with the observations in non-cyclosporine-treated recipients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Eurotransplant. Part II. The cyclosporine era 1981-1985. 315 58

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

Since 1981, more and more transplant centres collaborating within the Eurotransplant Organization started to use Cyclosporin-A (CsA) as part of their immunosuppressive protocols. Although these protocols differ from centre to centre it was felt important to study the clinical significance of CsA on renal allograft survival, especially with regard to other relevant but more constant factors such as HLA-A, -B and -DR matching, pretransplant blood transfusions, ischemia times, etc. This study encompasses 3150 transfused kidney transplant recipients of whom 765 have received CsA. Analysis shows that the group of CsA treated patients had a significantly better graft survival as compared to the non-CsA treated patients i.e., 71% versus 62% at 2 years respectively. The best kidney graft survival was obtained in the HLA-DR well matched donor-recipients combinations even when CsA was used (79% at 2 years). A significant adverse effect of prolonged cold ischemia times was observed when CsA was administered.
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PMID:Cyclosporin-A experience in Eurotransplant--preliminary data. 391 69

Because few HLA-DR-positive cells are present in the fetal spleen and liver, full HLA typing cannot be performed. However, B lymphocyte precursors can be transformed with Epstein-Barr virus to produce lymphoblastoid cells which express HLA-A, B, and DR antigens. Successful transformation was achieved, usually with spleen and liver, in nine fetuses aged from 15 to 18 weeks, mostly within 7 to 14 days of initiation of the cultures. Spleen-derived lymphoblasts were more suitable for typing because of their greater homogeneity and higher viability. Tissues from two 13-week fetuses from prostaglandin-induced abortions and from a spontaneously aborted 22-week fetus could not be transformed. This is probably attributable to prolonged ischemia before the tissues were obtained but, in the 13-week fetuses, absence of B lymphocyte precursors was not excluded. HLA-DR typing may be useful in obtaining well matched donor-recipient pairs in fetal pancreatic islet transplantation.
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PMID:HLA-DR typing of fetal human spleen and liver lymphoblastoid cells transformed by Epstein-Barr virus. 628 97

We analyzed 118 renal transplants performed from November 1977 through October 1981 to determine the effect of recipient race on graft and patient survival. Fifty-one cadaver and three living related transplants were performed in the black recipients and 41 cadaver and 23 living related transplants in the white recipients. No significant differences existed between the groups in regard to age, incidence of pretransplant nephrectomy or splenectomy, warm ischemia time, perfusion time, panel-reactive alloantibody (PRA) status, or number of pretransplant blood transfusions. The mean HLA-A and -B locus match was significantly less in black cadaver recipients and the incidence of malignant hypertension was significantly greater in black recipients. The one-year graft survival rate was 54.9% for black cadaver recipients and 48.7% for white cadaver recipients with a corresponding patient survival rate of 86.2% and 85.3%. The one-year graft survival rate for living-related recipients was 100% for blacks and 73.9% for whites with a corresponding patient survival rate of 100% and 86.9%. These results were not significantly different. When the recipients were matched for age, pretransplant transfusions, HLA-A and -B locus matching, and PRA status, no difference in transplant outcome was identified. We concluded that recipient race is not of prognostic significance in determining the outcome of either cadaver or living related donor transplantation.
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PMID:Recipient race as a risk factor in renal transplantation. 636 77

A total of 23,607 cases transplanted in 1975-1982 were analyzed for proportion and survival trends within eleven classification variables. Increases of up to 2% of total cases per year in proportions of registered transplants over the eight years are found in the following subcategories (with corresponding decreases in complementary subcategories): first grafts, cadaver donors, recipients with diabetes mellitus, and kidneys shipped more than 50 miles. Larger proportional increases of 3-7% per year are found for HLA-DR matching, cold ischemia times greater than 24 hr, cold storage, and pretransplant transfusions. Recipient population cross-sections are unchanged for age, race, HLA-A,B matching, and cytotoxic antibodies at transplant. Only the pretransplant transfusion classification has no increased graft survival in any subcategory; all other variables have one or more categories with increasing graft survival. It appears likely that the marked shift in transfusion policy nationwide has been the primary factor in increasing graft survival rates overall.
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PMID:Kidney transplantation trends from UCLA registry Data, 1975-1982. 636 42

Remarkable increases in cadaveric renal transplant survival rates have been seen following improvements in areas such as immunosuppression, organ preservation, HLA typing and cross-matching, and blood transfusion protocols. However, while these improvements have influenced survival in the early post-transplant period up to 6 months, the cumulative rate of graft loss beyond the 1st year has remained constant at about 9% a year over the past 25 years. Several factors that affect long-term survival have been identified through univariate and multivariate analyses. Chief among these is the detrimental effect of HLA-A and HLA-B antigen mismatching. Also important are the recipient's race, sex, and age, and presence of diabetes, as well as the donor's age, sex, and cause of death, and long cold ischemia times. Likewise, post-transplant events, including delayed graft function, early rejection episodes, and discharge serum creatinine levels strongly affect long-term graft survival. Chronic rejection should also be recognized as a major contributor to the long-term failure rate, but there is currently no reliable way to identify or classify it in the UNOS Scientific Renal Transplant Registry database. Characteristics that define chronic rejection must be identified to allow transplant centers to accurately report its incidence and to enable investigators to analyze and monitor its impact on transplant outcome.
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PMID:Outcome statistics of renal transplants with an emphasis on long-term survival. 806 74

Univariate and multivariate analyses have been performed on donor an d recipient variables to determine possible effects on the outcome of 516 primary cadaveric renal transplants performed in our single center from 1989 until 1993. The overall actuarial patient survival at 1 year and 5 years was 94.4% and 87.4%, respectively; the 1 year and 5 year graft survival rates were 88.3% and 77.8%, respectively. A total of 95 grafts were lost; death with function (35%) and chronic rejection (22%) were the major causes. Three variables (HLA-DR mismatch, delayed graft function, and prolonged cold ischemia time) had a significant detrimental effect on both short- and long-term graft survival. Zero HLA-DR mismatched grafts showed significantly enhanced survival over those with 1 HLA-DR mismatch both at 1 year (92.8% vs. 84.5%) and at 5 years (88.3% vs. 73.9%) only if cold ischemia time was less than 26 hours (P=0.0009). Occurrence of delayed graft function significantly lowered graft survival at both 1 year and 5 years (P=0.002), and the incidence was significantly associated with prolonged cold ischemia time (P<0.0001). HLA-A or HLA-B matching, percentage panel reactive antibodies (PRA), and anastomosis time showed no independent effect on long-term survival. The small number of 2 HLA-DR mismatched grafts (n=6) precluded separate analysis of this group. Acute rejection accounted for 12% of losses but had no statistically significant effect on graft survival, even though an increased frequency of rejection episodes was significantly associated with HLA-DR mismatch (P<0.0001). These results would suggest that significant survival benefits may be achieved by prospective HLA matching if cold ischemia times are limited. The efficiency of organ sharing must he improved to make optimal use of a limited resource.
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PMID:Importance of minimizing HLA-DR mismatch and cold preservation time in cadaveric renal transplantation. 860 72

Donor-recipient histocompatibility, as evaluated by the HLA matching results, plays an important role in the outcome of renal transplants, although much controversy surrounds the benefit of kidney allocation based on HLA typing. In this report HLA matching and survival data on 1,342 transplants performed at the University of California at San Francisco between 1984 and 1992 and treated uniformly by quadruple immunosuppression were analyzed in relation to the recipient's age. With respect to the influence of the increasing number of mismatches from 0 to 6, the analysis revealed decreasing 3-year graft survival rates as follows: 85.4%; 87.3%; 71.3%; 78.2%; 75.8%; 70.9% and 67.5%. Whereas the impact of cold ischemia time and histocompatibility was equally important during the 3-year postoperative period, the essential positive influence of good HLA matching on the long-term graft survival was demonstrated. The children aged between 5 and 18 years were identified as a high-risk group by the analysis, HLA-A incompatibility being attributed to poor graft survival in this age group. With respect to the effect of HLA-A histoincompatibility, the data provide evidence that HLA-A matching results seem to play an important role in graft survival in children, whereas transplants well matched in terms of HLA-B did well in adult recipients. No age difference in the impact of HLA-DR could be detected. In conclusion, HLA matching is still essential. It seems that there are differences in the impact of HLA loci in relation to the recipient's age.
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PMID:[Effect of HLA compatibility on the transplanted kidney in relation to recipient age]. 865 Aug 46


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