摘要:

Background.Auxiliary partial orthotopic liver transplantation (APOLT) has recently been performed in patients with noncirrhotic metabolic liver diseases. However, long-term outcomes for the preserved native liver and the transplanted liver graft have not been clearly established yet.Methods.The recipient was a 36-month-old girl with ornithine transcarbamylase deficiency. She underwent APOLT, using her father's left lateral segment.Results.Liver function was normalized soon after APOLT and the patient was able to ingest a normal diet without medication. Coexistence of the well-functioning native liver and graft was demonstrated in a computed tomography scan, Doppler ultrasonography, scintigraphy, and histological examination, during a relatively long-term follow-up period.Conclusions.APOLT seems to be most useful for the treatment of noncirrhotic metabolic liver diseases.

ISSN:0041-1337    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Prophylactic cholecystectomy for asymptomatic cholelithiasis is sometimes required before transplantation. However, there is little indication in the literature that transplant recipients are at any greater risk than individuals in the general population.Between January 1990 and December 1993, 211 renal transplant recipients underwent duplex sonography. All were asymptomatic. Twenty-one had positive findings: gallstones were found in 15 patients (7.11%) and sludge was found in 6 (2.84%). Of gallstone patients, seven (3%) were men and eight (4%) were women. One gallstone patient also had diabetes mellitus. The mean age by gender of the patients with calculi was 54 years for men and 38 years for women. Thirteen of the 15 patients with calculi (87%) have remained asymptomatic. Two patients (one diabetic) developed acute cholecystitis and underwent uncomplicated laparoscopic cholecystectomy. Patients with sludge were similar in gender and age to patients with gallstones; one patient had diabetes. No sludge patients became symptomatic.The incidence and morbidity of gallstones after kidney transplantation are low. Prophylactic cholecystectomy in asymptomatic patients before transplantation is not justified.

ISSN:0041-1337    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Hypertension and nephrotoxicity frequently occur in patients who receive cyclosporine therapy after bone marrow transplantation (BMT). Isradipine, a calcium channel entry blocker, has been used successfully in cyclosporine-induced hypertension.Methods.Thirty leukemic patients who received cyclosporine after BMT were randomized to receive isradipine (0.005 mg/kg) from 72 hr before commencement of cyclosporine therapy until day 100 after BMT or placebo.Results.The placebo and isradipine groups were well matched. No differences were found between the isradipine and placebo groups in the level of blood pressure, renal function, marrow engraftment, or mortality. Hypertension incidence was surprisingly low (30% a week after hospital discharge and 10% by day 100 after BMT), and did not differ between the groups.Conclusions.Isradipine does not harm immunohematopoietic reconstitution after BMT; therefore, it may be used in this setting, although the previously reported incidence of hypertension has been exaggerated.

ISSN:0041-1337    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.We have demonstrated that cyclosporine (CsA) stimulates transforming growth factor (TGF) β1expression in vitro and that growth of mammalian cells can be arrested by CsA via a TGF-β1-dependent mechanism. Herein, we have explored whether CsA stimulates TGF-β1hyperexpression in vivo.Methods.Four groups of B6AF1 mice were studied: group 1, control; group 2, CsA pretreatment; group 3, anti-CD3 monoclonal antibody pretreatment; and group 4, CsA plus anti-CD3 pretreatment.Results.CsA pretreatment augmented TGF-β1protein expression and increased intrarenal display of TGF-β1mRNA. This heightened TGF-β1expression was associated with an impaired T cell proliferative response.Conclusions.Our observations, together, advance the hypothesis that CsA might function in vivo as an immunosuppressant not only by inhibiting the expression of proinflammatory cytokines (e.g., interleukin 2), but also by stimulating the expression of TGF-β1, a potent immunosuppressive cytokine. Moreover, prevention of TGF-β1hyperexpression might prevent CsA-associated renal fibrosis, as TGF-β1is a fibrogenic cytokine.

ISSN:0041-1337    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

V antigen is an established virulence factor ofYersinia pestis,the causative agent of bubonic plague. Injection of homogenous staphylococcal protein A-V antigen fusion peptide into mice was previously found to suppress tumor necrosis factor-α and interferon-γ necessary for generation of protective granulomas. Here, we show that BALB/c mice receiving daily intraperitoneal injections of 100 μg of control protein A initiated rejection of C57BL/6 mouse tail skin grafts after 6.2±1.1 days. This time doubled to 12.2±1.4 days upon similar administration of protein A-V antigen fusion peptide (P<0.001); times of total allograft retention remained constant. This finding indicates that V antigen can postpone inflammation known to be associated with recognition and destruction of foreign tissue by T lymphocytes.

ISSN:0041-1337    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

T lymphocyte activity is enhanced by costimulatory signals mediated through CD28 binding to B7-1/B7-2 on antigen-presenting cells. Several recent studies have shown that graft-versus-host disease (GVHD) can be inhibited by in vivo treatment with CTLA4Ig, which blocks CD28-B7 interactions. These findings prompted us to investigate the role of CD28 in acute GVHD, using gene-targeted mice. We performed the experiments in the context of strong allogeneic MHC stimulation (H2banti-H2d) and weak stimulation (H2danti-H2b). In both directions, efficient in vitro T-cell cytotoxicity and acute lethal GVHD were induced by CD28-deficient lymphocytes, which was only partially delayed when compared with wild-type mice. We conclude that lethal GVHD can develop without costimulation via CD28.

ISSN:0041-1337    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A 55-year-old woman underwent orthotopic liver transplantation for autoimmune chronic active hepatitis. Extensive portal and superior mesenteric venous thrombosis precluded standard portal venous reconstruction and necessitated use of a venous conduit from the recipient splenic vein of the donor liver. Flow through this conduit was poor, however, and to prevent subsequent portal venous thrombosis and graft loss, the conduit was arterialized by end-to-side anastomosis with the recipient hepatic artery. This ensured graft survival but resulted in prehepatic portal hypertension, which required ligation of the arterioportal fistula for 4 months. The patient had a satisfactory outcome.

ISSN:0041-1337    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A 28-year-old woman with end-stage renal disease secondary to diabetes mellitus and hypertension underwent cadaver renal transplant in April 1992. After surgery, she developed bilateral breast enlargement while she was taking cyclosporine for immunosuppression therapy and felodipine, a calcium channel blocker, for blood pressure control. She underwent bilateral reduction mammoplasty in June 1995 to treat progressive breast enlargement which interfered with her normal life activities. Through mechanisms only partially understood, calcium channel blockers and cyclosporine are reported to increase the serum prolactin level, producing gynecomastia in men. There is no report in current literature to support a similar phenomenon in women.

ISSN:0041-1337    

出版商:OVID    

年代:1997

数据来源: OVID