摘要:

Postoperative intrarenal pressure measurements may be an aid to the diagnosis of acute renal transplant rejection, especially in patients treated with cyclosporine. Serial measurements of intrarenal pressure were made in 38 recipients using a fine-needle technique. Thirty-two intraoperative and 207 postoperative measurements were made, and 39 clinical rejection episodes (23 confirmed by biopsy) monitored. Intraoperative pressures in grafts with immediate function (37.4pM4.0 mmHg, meanpMSEM) were not significantly different from those with delayed function (30.9pM4.8 mmHg), whereas postoperative pressures were greater (P<0.01) in kidneys with acute tubular necrosis (29.4pM 1.9 mmHg) than in functioning grafts (20.4pM0.9 mmHg). Pressures recorded during clinical rejection episodes (44.3pM2.3 mmHg) exceeded (P<0.001) those during quiescent periods (23.6pM1.0 mmHg). During rejection episodes, higher pressures (P<0.01) were recorded from tender or palpably enlarged grafts (52.5pM3.0 mmHg) than in the absence of these signs (36.3pM3.1 mmHg), and patients whose transplants biopsies showed cellular rejection tended to have greater pressures (50.1pM4.1 mmHg) than those with concomitant vasculopathy (36.4pM3.9 mmHg), but the latter did not reach statistical significance. In 7 cases of cyclosporine toxicity the intrarenal pressure was 17.8pM4.2 mmHg. Using a diagnostic cut off point of 40 mmHg, the investigation failed to recognize 26% of acute rejection episodes–and, in the presence of acute tubular necrosis, it wrongly categorized 21% of nonrejectors. While its predictive capacity was limited, the test may occasionally be helpful in the differentiation of cyclosporine toxicity and rejection in functioning kidneys.

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Cultured BALB/c (H-2d) thyroid allografts, which are accepted permanently in fully immunocompetent allogeneic CBA/H (H-2k) recipients, are rejected following the transfer of immune spleen cells generated by immunization of recipient-strain mice with P815 (H-2d) which, like the cultured thyroid, expresses only class I major histocompatibility (MHC) antigens. Depletion of Lyt 2+T cells from the transferred population abolished the capacity of immune spleen cells to trigger rejection, whereas depletion of L3T4+T cells was without effect. Transfer of in-vitro-activated H-2dspecific Lyt 2+T cells also triggered rejection of cultured thyroid allografts. The results are consistent with previous studies showing that sensitized Lyt 2+T cells are required for rejection of cultured pancreatic islet allografts, which also express only class I MHC antigens. These results are in accord with the notion that Lyt 2+T cells are activated by and are active against class I MHC antigens.

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Islets were isolated using neutral red as a dye to exclude lymphatic and acinar impurities in the transplant preparation. In a one donor–one recipient model, intra-portally transplanted isogeneic islets survived indefinitely. Mean graft survival could be prolonged from 5 to 90 days, using a 3-dose rejection prophylaxis with CsA in allografts of (DA [RTla] Lew (RT 11). Histological examination revealed intact islets in the grafted normoglycemic animals. Immunohistochemical staining of these islets showed B cells with insulin-rich cytoplasma. Blood glucose levels and the results of i.v. glucose tolerance tests 50 days after transplantation are presented. The different outcomes of our experiments are discussed.

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Because of the nephrotoxic action of trimethoprim-sulfamethoxazole (TMP-SMX) in cyclosporine (CsA)-treated patients, combined with the possibility of selecting resistant gram-negative or Nocardia asteroides organisms, a monitoring tool to detect early Pneumocystis carinii (PC) infection permitting a selective treatment approach is highly desirable. A review of 401 consecutive renal transplants revealed 26 cases (18 suspected and 8 histologically proved) of PC infection in 21 cadaver and 5 living-related renal recipients. The diagnosis was confirmed in 8/18 patients who were inva-sively studied by open-lung biopsy (1/2), bronchoscopy with transbronchial biopsy (4/9), bronchoscopy with brushing (1/2), bronchoscopy with bronchoalveolar lavage (2/5), and transpleural needle biopsy (0/1)-yielding a confirmed incidence of 2% (8/401). All positive invasive studies had been performed prior to or within 24 hr of the inception of TMP-SMX therapy. Nine of ten negative invasive studies were performed after more than 24 hr of treatment. The mean time from transplantation to the onset of clinical symptoms was 2.5pM1.5 months. The infection rate would be 6.5%, assuming all 18 suspected cases would be PC-positive if studied pre-treatment. In order to assess the efficacy of a variety of serologic methods of PC detection, qualitative counter-immunoelectrophoresis (CIE) forP cariniiantigen (PC-Ag), IgG antibody reactive with PC (enzyme-linked immunosorbent assay [EI,ISA]), and a latex particle agglutination test (LPA) were performed on 279 sera; 85 sera from the 26 suspected or proved cases, 100 sera from normal age-matched controls, and 94 sera from 78 asymptomatic allograft recipients followed as outpatients. In the eight histologically proven cases, CIE was positive in only 3/8 and turned positive late in the clinical course. LPA was positive in all histologically proved cases; however, it was also positive in 60% of asymptomatic renal recipients. In cases that developed clinical disease, LPA increased in titer weeks to months prior to the onset of symptoms. Additionally, LPA titers decreased or stabilized during successful TMP-SMX therapy, providing an early therapeutic index. Measurement of anti-PC IgG was not useful per se, as it was elevated in both controls and documented PC infection. The combination of very low antibody titer (≤1:16) with a positive or increasing LPA PC-Ag titer appeared to be disease-predictive. Both histologic and serologic criteria appeared to indicate an increase in P carinii pneumonia (PCP) incidence in this transplant population. Serial studies of LPA PC-Ag and ELISA PC antibody titers will aid in the development of monitoring tools to improve the care of transplant recipients at high risk for PC infection.

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The sera of 45 hypersensitized patients with more than 90% panel reactive antibodies were tested for reactivity against peripheral blood T lymphocytes from 7 donors matched for HLA-A.B antigens. The target cells were phenotypically homozygous HLA-A1.B8 or A2.B44. Tests for lymphocytotoxic antibodies were essentially negative except for one target cell in which 10 of 25 sera were positive. More positive reactions were detected by flow cytometry, and the proportion of positive specimens ranged from 15% to 48% with the different target cells. Most positive reactions involved the HLA-A2 and B44 antigens, in which heterogeneity within the serologically defined specificities has been described. The positive reactions were further evaluated by testing the effect of purified soluble HLA molecules on the binding of antibodies to the HLA-marched targets. Purified HLA produced a detectable inhibition of antibody binding in the majority of the serum-target combinations studied. These results document that anti-HLA antibodies can still react with HLA-matched lymphocytes, which may be due to the recognition of subtypes of the known serologically defined specificities

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Serial plasma samples of 1 72 kidney transplant recipients and 12 chronic dialysis patients were evaluated retrospectively in a radioimmunoassay to determine the clinical relevance of plasma neopterin levels. Dialysis patients had a higher neopterin level 196pM82 nmol/L (meanpMSD) than 70 healthy controls (7pM4 nmol/L). In 45 patients with a completely uneventful postoperative course, elevated pretransplant neopterin levels dropped rapidly within a week to a mean of 30 nmol/L and remained stable thereafter. In 22 outpatients with stable graft function there was a highly significant correlation between 170 paired serum creatinine and plasma neopterin values (r = 0.91). A group of 13 patients had experienced delayed graft function (ATN) without rejection. Their one-week mean neopterin level was 100 nmol/L and continued to drop in parallel with the serum creatinine. Another 15 patients rejected their kidneys irreversibly within 3 weeks-B of them had extremely high neopterin levels during the rejection process (range 500–1000 nmol/L) that were not seen in other patients. A total of 1B9 rejection episodes in 43 patients were treated with bolus-dose cortisone. On the day of bolus therapy, both serum creatinine (P<0.002) and neopterin (P<0.005) were elevated. At 24 hours prior to bolus cortisone therapy, creatinine levels were not significantly elevated, whereas there was a significant rise in plasma neopterin (P<0.01). The overall sensitivity of neopterin increase was 86% with a 17% probability of false positives, and the sensitivity was 95% in biopsy-proved rejections. Plasma neopterin appears to be a useful marker for early detection of rejection and for identifying severe rejections that are not responsive to treatment

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In order to assess the impact of demographic factors on serum levels of cyclosporine (CsA) estimated by radioimmunoassay (RIA) in renal allograft recipients, 493 pharmacokinetic studies were performed in 212 patients. Neither the presence of diabetes mellitus nor the CsA dosing frequency affected the measured pharmacokinetic parameters. Age over 45 years led to slower CsA clearance with resultant increase in maximum serum concentration (Cmax) per administered milligram, and increased volume of distribution. Female patients showed more rapid drug clearance, but greater volume of distribution. Concomitant hepatic impairment reduced drug clearance, increasing the area under the curve (AUC) per administered milligram of drug, and the Cmax. Patients treated with a rapid steroid taper showed a shorter half-life and lower Cmax than those receiving a slow steroid taper. Nephrotoxicity was associated with increased AUC per administered mg, while patients with acute tubular necrosis requiring dialysis showed poorer drug absorption, lower Cmax, and longer time to peak. The only effect of cimetidine administration was a slightly shortened time to peak. Serial analyses posttransplant in 17 patients suggested a tendency toward improved drug absorption with no effect on other parameters. These studies demonstrating the significant impact of demographic factors thus afford a basis on which to predict the trend of anticipated CsA levels as measured by RIA in renal allograft recipients

ISSN:0041-1337    

出版商:OVID    

年代:1986

数据来源: OVID