摘要:

Using nonimmunosuppressed piglet small bowel grafts, we performed a detailed histological study on acute rejection and analyzed altogether 45 different histological parameters throughout the bowel wall, in 10 allografts and 6 autografts. Heterotopic grafts were followed by full-thickness biopsies every other day beginning on the 3rd day after transplantation. The parameters were scored from 0 to 3 according to the severity of the change and the values of every variable were compared statistically between the 2 groups. The earliest significant changes, beginning on days 3–5, were infiltration of inflammatory cells and pyroninophilia among these cells in lamina propria; edema, fibrosis, and inflammation in sub-mucosa and muscularis; vacuolar degeneration of myocytes; and endothelial and intimal changes in vessels. Villous blunting and cuboidal epithelium were the other early markers. On day 7, the epithelial and vascular changes became most significant. We want to emphasize especially the vascular parameters: endothelial swelling and proliferation, intimal thickening, intramural inflammation, and obliteration of the lumen. The dilatation of lymph vessels and changes of Peyer's patches had no value in the estimation of rejection. All allografts became necrotic by day 11 after transplantation.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Phosphate-buffered sucrose (PBS) has been shown to be highly effective for renal graft storage. It may, therefore, be useful for lung graft storage. Recent studies have suggested a possible role for University of Wisconsin (UW) solution in lung preservation. The object of this study was to evaluate these two solutions in comparison with EuroCollins (EC) solution for lung graft preservation in an isolated rat lung model. Lungs were stored for 6 hr at 4°C after a single pulmonary artery flush with either PBS with prostacyclin (n=10), EC with prostacyclin (n=5), or UW (n=5) solution. Re-perfusion of the isolated lung was carried out for 1 hr using a venovenous extracorporeal circulation from a ventilated support rat. The support animals and isolated lungs were ventilated with room air. Control values were obtained from lungs reperfused immediately after harvesting (n=5). At 1 hr, PBS provided a similar level of protection to EC: pO2, 45±10 mmHg and 54±6 mmHg; graft blood flow, 4.1±1.2 ml/min and 3.5±0.42 ml/min; peak airway pressure, 32±2.5 mmHg and 36±3.6 mmHg; weight gain, 4.1±0.6 g and 4.2±0.6 g, respectively (P=NS). However, the UW group provided superior function, which was similar to the control group: pO2, 128±2.7 mmHg and 126±5 mmHg; graft blood flow, 9.9±0.4 ml/min and 10.2±0.8 ml/min; peak airway pressure, 17.6±0.4 mmHg and 16.5±0.6 mmHg; weight gain, 0.12±0.1 g and 0.19±0.13 g, respectively (P=NS). UW was superior in all parameters to PBS and EC (P<0.001). This suggests that the renal solutions PBS and EC are inappropriate for lung graft preservation, and that the requirements of the lung during hypo-thermic storage differ from those of the kidney.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Prostanoids such as prostacyclin and thromboxane A2have recently been suggested to play important roles in cold ischemia/reperfusion injury. The purpose of this study was to investigate the effect of thromboxane A2synthetase inhibitor (OKY-046) on cold-stored livers of the rat using an ex vivo perfusion system. Addition of OKY-046 to preservation solution and the perfusate of livers stored cold (4°C) in lactated Ringer's solution resulted in significantly lower glutamic pyruvic transaminase release (3.01±0.86 IU/g liver vs. 1.79±1.08 IU/g liver at 120 min after perfusion;P<0.05), reduced perfusate ammonia levels (8.51 ±2.51 μg/dl/g liver vs. 3.62± 1.71 μg/dl/g liver at 60 min;P<0.05 and thereafter), lower perfusate taurocholate levels (0.63±0.10 vs. 0.18±0.05 at 15 min;P<0.01 and thereafter), perfusate hyaluronic acid clearance (0.934±0.132 vs. 0.76±0.127 at 30 min;P<0.05 and thereafter), and a reduced number of trypan blue-positive sinusoidal lining cells (50.1±9.9%; vs. 17.4±7.0%;P<0.01). Histologically, the liver preserved for 6 hr in simple cold lactated Ringer's solution exhibited interstitial edema, various degrees of hepatocyte swelling, and sinusoidal stenosis, as well as dilatation, while the livers treated with OKY-046 demonstrated much less hepatocyte swelling, and change in sinusoidal width was nearly absent. We conclude that OKY-046 reduces post-preservation reoxygenation injury by protecting sinusoidal endothelial cells and hepatocytes.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This prospective study characterizes the incidence, etiology, timing, risk factors, and outcome of the infectious complications after 88 consecutive liver transplantations in 79 patients receiving tacrolimus (FK506) as primary immunosuppression with a median follow-up of 880 days. Infections occurred in 59% (47/79) of the patients, and 39% had major infections. Of the major infections, 55% were bacterial, 22% were viral, and 22% were fungal. Bacteremia accounted for 30% of major bacterial infections. Sixty percent of bacteremias occurring within the first 3 months were catheter related, while 75% of those occurring more than 3 months after transplant were of a biliary source. Patients with recurrent hepatitis C virus hepatitis and patients requiring dialysis after transplant had a significantly higher rate of infections as compared with other patients. Overall mortality was 18%, and 29% of all deaths were associated with infection. Only invasive aspergillosis was associated with infectious mortality. Our data suggest that the potent immunosuppressive agent FK506 is not associated with a higher incidence of infectious complications as compared with previous studies using CsA.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Cytomegalovirus disease is an important cause of morbidity following liver transplantation. To date there has not been an effective prophylaxis for CMV disease after liver transplantation. One hundred forty-three patients were randomized to receive either high dose oral acyclovir (800 mg 4 times a day) alone for 3 months after transplantation (acyclovir group) or intravenous ganciclovir (5 mg/kg twice a day) for 14 days followed by high dose oral acyclovir to complete a 3-month regimen (ganciclovir group). Of 139 patients available for evaluation, 43 of 71 (61%) patients from the acyclovir group developed CMV infection compared with 16 of 68 (24%) from the ganciclovir group (relative risk, 3.69; 95% confidence interval, 2.07–6.56;P<0.00001). Of those randomized, CMV disease was seen in 20 (28%) of the acyclovir group compared with 6 (9%) of the ganciclovir group (relative risk, 5.11; 95% confidence interval, 2.05–12.75;P=0.0001). The median time to onset of CMV infection was 45 days in the acyclovir group compared with 78 days in the ganciclovir group (P=0.004). The median time to onset of CMV disease was 40 days in the acyclovir group compared with 78 days in the ganciclovir patients (P=0.02). With respect to primary CMV infection, there was no difference in the rates in the 2 groups, but tissue invasive disease and recurrent CMV disease were less frequent in the ganciclovir group. It is concluded that a course of 2 weeks of ganciclovir immediately after transplantation followed by high dose oral acyclovir for 10 weeks is superior to a 12-week course of high dose oral acyclovir alone for prevention of both CMV infection and CMV disease after liver transplantation. However, the lack of significant effect in sero-negative recipients who received grafts from sero-positive donors suggests that other strategies are needed to prevent CMV infection in this high risk population.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In liver transplantation (LTx), numerous studies have failed to demonstrate an adverse effect of HLA-A,B,DR incompatibility or of donor-specific positive cross-match on survival of the recipients. In this study, we examined the effect of antidonor cytotoxic antibody and HLA compatibility in 800 LTx recipients with CsA-based immunosuppression. Thirty-four of 482 (7%) recipients were transplanted across a positive donor-specific T cell cross-match. Four-year patient and graft survival was 71% and 67%, respectively, in negative cross-match recipients and 53% and 50%, respectively, in positive cross-match recipients (P=0.0051 andP=0.023). Neither B cell-positive cross-match nor the presence of panel reactive antibody (PRA) had an adverse impact on the liver allograft outcome. Interestingly, 21/58 (36.2%) patients with PRA ≤ 10% had a positive T cell cross-match, whereas only 7/382 (1.8%) patients with PRA < 10% did (P<0.0001). This indicates the predictive value of PRA cross-match results. B lymphocyte cross-match results also were strongly correlated with the presence of PRA, as 26/57 (45.6%) of the patients with PRA ≥ 10% had a positive cross-match, whereas only 22/394 (5.6%) with PRA < 10% did (P<0.0001).Analysis of HLA compatibility demonstrated a significant impact on patient's survival, comparing only 0–2 vs. 6 HLA-A+B+DR mismatches and 0 vs. 1 vs. 2 HLA-DR mismatches. Four-year patient survival rate for 0 to 2 antigen mismatches was 86%, whereas for 6 antigen mismatches it was 62% (P=0.025). Overall actuarial 4-year patient survival rate in HLA-DR-mismatched groups (0 vs. 1 vs. 2) was 84%, 73%, and 64%, respectively (P=0.033). In no mismatched category was graft survival rate significantly different. Sepsis or rejection was the cause of graft loss in 1/10 (10%), 21/75 (28%), and 34/85 (40%) patients with 0, 1, and 2 HLA-DR mismatches, respectively.The difference between patient and graft survival was accounted for by survival after retransplantation, which was lower in patients with more HLA-DR mismatches in primary transplants. The latter group received intensive immunosuppressive therapy during the first month after primary transplantation, as compared with those with fewer HLA-DR mismatches (P=0.04).

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Sixty-two OLTs in 61 patients were performed using a technical modification reported recently, including total hepatectomy with preservation of the inferior vena cava, partial clamping of the native vena cava, and side-to-side cavacaval anastomosis. We further modified the technique by adding the early construction of a temporary end-to-side portacaval shunt, and, more recently, by using an end-to-side caval reconstruction. With this technique, the caval and portal flows were maintained throughout the procedure. Hemodynamic parameters were analyzed prospectively during the operative period and remained stable at all stages of the procedure. Venous bypass was avoided in all cases without need for increased fluid infusion. Operative time and transfusion requirements were 6.8±1.6 hr and 9.8±4.3 U of packed RBC, respectively. There were no specific complications or deaths due to the technique used and hospital mortality was 10% (6/61). The technique used in this study is a safe adjunct to the technical armamentarium of clinical liver transplantation. Its main advantage seems to be hemodynamic stability throughout the procedure, obviating the need for venous bypass or fluid overload.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The authors report their experience with 6 patients requiring liver transplantation who suffered with liver infestation byEchinococcus granulosus.One patient presented with acute Budd-Chiari syndrome because obstruction of hepatic veins was produced during the first operation; the other 5 patients received liver transplants for terminal chronic liver disease (2 secondary sclerosing cholangitis, 2 secondary biliary cirrhosis, and 1 postnecrotic cirrhosis of the liver). All the patients had been operated previously on for hydatidosis and were at the end of liver functional disorder. Some of the patients had undergone many operations, making the transplantation procedure even more difficult. One patient required a second transplant for primary graft failure; he died 40 days later from cerebrovascular accident. Another patient died 7 months after transplant from pulmonary embolism. The other 4 patients are alive and in optimal condition 37–65 months after transplantation. Hepatic hydatidosis—in principle, a benign disease—can cause hepatic complications that eventually require liver transplantation. The transplantation procedure is more difficult than usual in these cases. Although postoperative complications are frequent, most patients achieve prolonged survival and a good quality of life.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A retrospective examination was performed, including a case control study, of 40 patients aged 60 years and over who underwent liver transplantation at King's College Hospital, London, UK, between 1988 and September 1993. There was no significant difference between elderly patients and younger patients in preoperative condition, intraoperative interventions, or outcome assessed by survival, complication rate, and duration of stay on the intensive care unit. The only significant difference between age groups was the median length of hospital stay, which was 24 days for the elderly versus 20 days for younger patients. We conclude that age up to 70 years should not be a barrier to liver transplantation.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Thioguanine nucleotides (6-TGN) are intracellular metabolites that may contribute to the antiproliferative effects of AZA. The objectives of our study were to describe the variability of 6-TGN concentrations during AZA therapy and to investigate possible correlations between 6-TGN levels and subsequent myelosuppression. We measured 6-TGN concentrations in RBC of 65 renal transplant recipients from day 0 until 11–64 days after transplantation. High 6-TGN concentrations were observed in relation to elevatedS-creatinine. In 15 patients, 6-TGN concentrations above 200 pmol/8×108RBCs were measured (high 6-TGN group: mean maximal 6-TGN = 552 pmol/8×108RBCs, SE = 91). In the remaining 50 patients, mean maximal 6-TGN was 82 pmol/8×108RBCs, SE = 6.1 (low 6-TGN group). In the former group, meanS-creatinine measured on the day of maximal 6-TGN was 466 μmol/L (SE = 62.3), while in the latter it was 190 (SE = 14.7). In the high 6-TGN group, we observed a lower mean nadir neutrophil count than in the low 6-TGN group (3.4 vs. 5.1 × 109neutrophils/L). The nadir neutrophil count occurred, on the average, 12.7 days after maximal 6-TGN in the high 6-TGN group, with no such delay in the low 6-TGN group.

ISSN:0041-1337    

出版商:OVID    

年代:1994

数据来源: OVID