摘要:

Split-liver transplantation (SLT) presents the opportunity to transplant children with size-matched organs without reducing the adult cadaveric liver pool. For reasons described below, SLT has not as yet gained general acceptance. The possible inferior quality of the right graft seems to be the major problem, hampering the general application of SLT. In an attempt to overcome this, the authors have developed a new concept, based on the technique of living-related liver donation, for splitting livers. This report describes the first case performed and discusses the rationale of the in situ split liver procedure.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The effect of rapamycin (RAPA) as graft pretreatment was evaluated in orthotopic small bowel and kidney allotransplantation (Tx) in the rat. In the small bowel Tx model, six groups were involved, each including three combinations for evaluation of host-ver-sus-graft (HVG) [Lewis (LEW) × Brown Norway (BN) (LBN)-F1→ Lewis], graft-versus-host (GVH) (LEW → F1), and combined HVG and GVH immune responses (BN → LEW). RAPA graft pretreatment alone (16 μg/ml × 3 ml) was able to induce a modest but significant prolongation of survival in all three combination models compared with controls (P<0.05). The same was observed for low dose CsA treatment (2 mg/kg/day × 14 days) of the recipient only (P<0.05). Combination of graft pretreatment with RAPA and CsA recipient treatment produced a marked prolongation of survival especially in HVG response. Recipients treatment with one 48-μg bolus of RAPA i.v. immediately after graft revascularization failed to achieve any prolongation of survival for the GVH or combined HVG and GVH responses. This seems to exclude a “carryover” effect of RAPA from graft to recipient. RAPA efficacy was also clearly confirmed in the kidney graft pretreatment model as compared to recipient treatment with an equivalent RAPA dose.These results demonstrate that graft RAPA pretreatment prolongs SB survival after Tx in the rat for HVG, GVH, and bidirectional immune responses. Intragraft interaction with passenger leukocytes or APC function appears as one of the possible mechanisms. RAPA graft pretreatment potentiates low dose CsA recipient treatment suggesting a possible use in clinical organ Tx.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The standard preservation technique in lung transplantation is cold single pulmonary artery flush (PAF) with Eurocollins solution (ECS). We compared ECS with University of Wisconsin (UW) solution, with and without added indomethacin, in single PAF preservation in an in vivo rabbit model of warm ischemiareperfusion lung injury.Six groups of four New Zealand white rabbits each underwent isolation and hilar stripping of the left lung. In the four experimental groups, the left lung was flushed with (15 ml/kg) of cold ECS or UW solution, with or without added indomethacin, before warm ischemia for 120 minutes and before reperfusion for 60 minutes. The remaining two groups were the nonischemic and the ischemic “no flush” controls. Transcapillary flux of99mTechnitium-labeled albumin and electron microscopy were used to demonstrate lung injury. Pulmonary vascular resistance (PVR) and thromboxane B2(TXB2) concentrations were measured.There was a significant rise in PVR after ischemia/ reperfusion in the ischemic control group (54.7±13.9 to 117.8±20.7 mm Hg/L-min-1,P<0.05). The net rise in PVR after ischemia-reperfusion was significantly smaller in the two groups in which indomethacin was added (16.8±17.5 and 4.5±10.6 mm Hg/L-min-1for UW and ECS, respectively) compared with the ischemic control (63.1±24.6 mm Hg/L-min-1,P<0.05). Postreperfusion TXB2levels tended to be lower in the nonischemic control group and in the indomethacin-flush groups.We conclude that the increase in PVR produced by unilateral ischemia-reperfusion lung injury in this model was improved by single PAF perfusion. There was no significant difference between UW solution and ECS in this regard. The addition of indomethacin to the flush solution was associated with lower PVRs as well as morphologic improvement by electron microscopy. These findings may indicate a prominent role for the provision of PG synthesis inhibition during preservation for lung transplantation.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Recent studies have indicated that, the administration of thromboxane A2(TxA2) inhibitors improved renal functions in experimental renal allograft transplantation. Thus TxA2, a vasoconstrictor metabolite of arachidonic acid, may play a role in renal function and blood flow during hypothermic storage. The aim of the present study was to evaluate the cytoprotective effect of TxA2synthase inhibitor, UK 38485, on altered renal function due to cold ischemia for 24 and 72 h. Experiments were performed in isolated perfused kidney from adult rabbits. Kidneys were perfused with Euro-Collins (EC) containing UK 38485 and incubated with the same solution in a beaker exposed to cold ischemia for 24 and 72 h. The same procedure was applied to the control kidneys in EC solution alone. Vascular responses and urinary output to noradrenaline, angiotensin II, endothelin-1, acetylcholine, and sympathetic stimulation were assessed as the functional activity of kidney. The addition of UK 38485 to EC solution increased the preservation time of kidney and protects the vascular endothelial regulatory functions and urine excretion when compared to EC alone. The results of the present study can be taken as an evidence of the cytoprotective effect of the UK 38485 and might be useful for kidney preservation.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A small number of kidney transplant recipients abruptly lose function secondary to acute renal artery or vein thrombosis or more rarely a form of necrotizing vasculitis. We report a group of four kidney transplant recipients who lost renal function and share the following features: (1) diabetes (type I, insulin-dependent diabetes mellitus, type II or steroid-induced); (2) abrupt changeAoss of renal function; (3) a concomitant clinical event (fever, viral symptoms, menometrorrhagia, viremia, bacteremia); (4) severe necrotizing vasculitis with hemorrhagic necrosis on histopathology; (5) patent renal artery and vein at time of transplant nephrectomy (i.e., no vascular thrombosis); and (6) high levels of peripheral serum γ-IFN 1–5 days before transplant nephrectomy (467 ±175 pg/ml) compared with that of patients experiencing severe rejection (8.4±3.7 pg/ml) (P<0.002). These data support the concept of a cytokine (IFN-γ)-mediated accelerated inflammatory response resulting in graft loss from necrotizing vasculitis—the clinical equivalent of an organ-specific Shwartzman reaction.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Noninvasive M mode echocardiography with Doppler recording was prospectively performed on type I diabetic recipients of pancreas-kidney (n=20), pancreas-after-kidney (n=2), and kidney-alone (n= 11) allografts to determine whether the return of euglycemia by pancreas transplantation in the uremic diabetic person was associated with improved cardiac function. Each patient was studied preoperatively and at 6 and 12 months posttransplant. Echocardiographic parameters which were compared included measures of systolic function (shortening fraction), diastolic function (early/active peak velocity ratio, early/active integral ratio), and left ventricular geometric parameters (interventricular septal thickness, posterior wall thickness, left ventricular mass).The only statistically significant improvement observed for kidney-alone recipients was an increased shortening fraction from baseline (24.91%) to 6 months (32.13%, P ≤ 0.0188). In contrast, the pancreas group demonstrated sustained improvement in all outcomes with measures at 12 months consistently showing a significant improvement from baseline which was also significantly better than that reported for the kidney-alone group.This study showed stabilization of cardiac function by echocardiography for diabetic kidney-alone recipients, whereas significant improvement in function occurred for pancreas-kidney recipients. The improvement in cardiac function for pancreas recipients was seen at 6 months with continued improvement evident at 12 months.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

IFN-γ and IL-10 secretion by sorted T cell subsets of irreversibly rejected kidney graft-infiltrating cells (GIC) and normal PBMC was studied by ELISPOT. The low spontaneous frequency of IFN-γ-producing cells (IFN-γ-PC) was strongly increased by anti-CD3 activation within unsorted, CD3+CD4+, and CD3+CD4-subsets of GIC and PBMC. In contrast with PBMC, IL-10-PC from GIC were at higher frequency within CD4+cells than among CD4-ones (P<0.03). Four kidneys removed after 3.7±0.8 months showed acute vascular rejection, high frequency of activated CD4+IL-10-PC (118±68 per 104cells), and high percentage of anticlass II antibody reactivity (87.6±6.3%). In contrast, four patients with kidneys removed later (53.7±1.6 months, P=0.02) displayed chronic rejection with superimposed acute cellular rejection, low frequency of CD4+IL-10-PC (7.0±3.0 per 104cells, P=0.02), and low percentage of anti-class II antibody reactivity (12.9±6.1%, P=0.02). Thus, accelerated vascular rejection appears to be associated with preferential production of IL-10 by activated CD4+GIC, which may act by shifting the effector arms of alloreaction toward humoral responses.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The increasing success of clinical liver transplantation has brought rejection to the forefront as a cause of morbidity and graft loss. The relationship of immunosuppressive drug doses and levels to acute and chronic rejection remains a matter of debate. The effect of blood CsA levels and drug doses on the incidence of acute and chronic rejection and the impact of acute rejection episodes on the occurrence of chronic rejection were studied in 146 grafts in 132 patients. These patients were transplanted in the 4-year period from June 1989 using CsA-based immunosuppression (CsA, azathioprine, prednisolone). Liver grafts in patients maintained on median CsA levels (whole blood, trough level) of >175 μg/L in the first 28 days post-transplant had a significantly lower incidence of chronic rejection (2 out of 49 vs. 22 out of 97; P=0.002). There was no significant difference in incidence of graft loss due to fatal sepsis (6% vs. 5%) or nephrotoxicity between the high and low CsA level groups. The overall graft loss rate was lower in the higher CsA level group (22% vs. 37%). The total doses of the individual drugs did not correlate with the incidence of acute or chronic rejection. Although the occurrence of acute rejection itself did not determine later chronic rejection, late occurrence (P<0.00001) and multiple episodes (two or more; P=0.0002) of acute rejection were significant risk factors for the occurrence of chronic rejection. We conclude that to minimize graft loss to rejection, CsA levels should be maintained at greater than 175 μg/L in the early posttransplant period, and late and recurrent episodes of acute rejection should be prevented.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The aim of this study was to assess the long term results of 43 ABO-incompatible liver transplantations performed in 40 patients. The 5-year patient and graft survival rates were 50 and 20%, respectively. In the group of patients transplanted in emergency for fulminant or subfulminant liver failure, ABO incompatibility had no significant impact on patient survival (P=0.09). Graft survival, however, was significantly impaired (P=0.0002) through a greater incidence of hyperacute rejection (20%), vascular thrombosis, and biliary injury (56%). Increasing the magnitude of immunosuppression and postoperatively reducing the titer of anti A/B antibodies by plasmapheresis had little influence on the incidence of these complications and were associated with a greater incidence of septic complications. These results indicate that the use of ABO-incompatible liver grafts is a life-saving procedure in patients with life-threatening acute liver failure, but at a high price. Justification for accepting or not accepting an ABO-incompatible graft in these emergency situations depends on the personal choice in giving priority to saving the patient in an acute life-threatening condition or to giving the graft the best chance of success. To avoid this difficult choice, efforts should aim at expanding the pool of grafts available in emergency, at developing artificial support devices that could allow to safely delay transplantation, or at more efficiently controlling the humoral response.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We compared the value of PCR on plasma with PCR on buffy coat leukocytes, Ag assay, and the determination of IgM antibodies by ELISA for the diagnosis and follow-up of cytomegalovirus infection. Thirty patients were followed after liver transplantation (LTX). We compared the tests to assess their clinical usefulness. Fourteen of 30 (46%) patients were both positive in plasma and buffy coat PCR and Ag test. Sixteen patients were negative in both procedures. There was a 97.2% concordance between PCRs done from plasma or buffy coat. The concordance of results of PCR and Ag test in single samples was 94.3%. Discordant results were found in 5.6% of samples. Discordance was observed in the early and the late phase of CMV infection and was due to positive PCRs preceding positive Ag tests for 1–3 weeks in one-half of the patients. IgM antibodies were first observed after a median period of 8 weeks (range, 6–11 weeks) after LTX. Positive PCRs and Ag tests preceded clinical manifestation of CMV disease by a 1 week median (range, 0–3 weeks), whereas positive IgM ELISAs occurred after a median period of 2.5 weeks (range, 0–4 weeks) after the onset of CMV disease. The sensitivity and specificity of both PCR and Ag test were identical, 100% and 76%, respec.

ISSN:0041-1337    

出版商:OVID    

年代:1995

数据来源: OVID