ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYSeven hundred sixty-seven primary renal allografts from a single center were divided into subgroups according to combinations of several major risk factors: donor source and histo-compatibility match, age, and presence or absence of diabetes. The relative effect of diabetes on patient and graft survival decreased as histocompatibility differences increased. The influence of recipient age, however, dramatically decreased as histocompatibility differences decreased. In all groups donor source and histocompatibility match had the strongest relative effect in determining subsequent 2-year patient and graft survival.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYThere is an increased incidence of Kaposi's sarcoma (KS) in organ transplant recipients in whom it comprises more than 3% of all de novo neoplasms. Any such patient who develops reddish blue macules or plaques in the skin or oropharyngeal mucosa, or has apparently infected granulomas that fail to heal, should be suspected of having KS. In 45% of the patients, the internal viscera are involved. This variety has a bad prognosis. Apart from conventional treatment with surgical excision, radiotherapy or chemotherapy, cessation, reduction, or modification of immunosuppressive therapy produces gratifying results in a significant number of patients.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYLeukocytotoxic antibodies of varied thermal reactivity have been identified in sera of patients pre- and post-transplant and cold antibodies have a reportedly favorable association with good renal allograft survival. Since leukocytotoxicity assays are usually performed only at room temperature (22 C), we questioned the presumption that both warm and cold leukocytotox-ins are reliably detected at 22 C. We sought to define the patterns of thermal reactivity of leukocytotoxic antibodies in alloimmune sera and to relate these antibodies to survival of renal allografts. In presensitized patients, we found with discriminating incubation conditions (15, 22, and 37 C) that pure warm and/or pure cold reactions constituted about 31% of positive reactions and these were missed with only 22 C incubation. Expression of thermal amplitudes is highly target cell-dependent and all three incubation temperatures are required to allow full expression of antibody reactivity of a serum. In 45% of the long-term allograft recipients, we detected circulating leukocytotoxins and room temperature tests missed 48% of the positive reactions. Presensitization was associated with poor graft survival but patients with warm or cold antibodies had graft survival rates approximating those in patients with no detectable antibody. Post-transplant, patients with circulating antibodies to greater than 10% of a panel had poor graft survival but again, those patients with pure warm or pure cold-reactive antibodies had graft survival rates similar to those patients with no antibody. In the majority of recipients with established allografts, no antibody could be detected but in the minority with detectable antibody, there was a slight predominance of the pure warm or cold antibody, compared with the thermal mixture antibody.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYTo investigate the high rate of recurrence and associated bacteremia in renal transplant patients with urinary tract infection (UTI), a prospective study was undertaken in 47 consecutive renal transplant patients, using the antibody-coated bacteria (ACB) assay to define the site of infection and the type of antibiotic therapy to be prescribed. Sixteen patients (34%) developed infection in the first 3 months after transplantation, with 14 of the 16 (88%) having positive ACB tests. In contrast, 3 of 47 patients (6%) developed UTI more than 3 months post-transplantation, all with negative ACB assays.The five patients with ACB-negative infection were treated with a conventional 2-week course of antibiotics, with 100% success. The 14 patients with ACB-positive infection were treated for 6 weeks with antibiotics, with eradication of the infection in 13 of the 14 instances (94%). The one exception, a patient with chronic rejection and poor renal function, relapsed within 48 h of discontinuing therapy, with blood and urine cultures positive for the original organism. No other instance of gram-negative bacteremia occurred in these 47 transplant patients.These results suggest: (1) The majority of UTIs in the transplant begin within 3 months of transplantation, with silent or overt infection of the allograft usually present. (2) The results of the ACB assay appear to correlate well with the response to antimicrobial therapy. (3) The use of prolonged antimicrobial therapy for ACB-positive UTI appears to decrease the frequency of bacteremia and relapsing infection.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYThe case studies of four patients with post-transplantation calcinosis are presented. Three of the four patients died of inanition and sepsis secondary to infection of extensive soft tissue ulcers and diffuse cutaneous vascular calcification with gangrene. The fourth patient survived following removal of all four parathyroid glands and autografting of approximately one-half of one gland. Common to the patients was secondary hyperparathyroidism, elevated mean serum calcium levels after transplantation, and radiographie evidence of small and medium vessel calcification. No other differences could be found between these patients and other patients with post-transplantation hyperparathyroidism without calcinosis. In the face of apparently minor complaints of lower extremity discomfort, elevated parathyroid hormone levels (PTH) and positive xerography may indicate subtotal parathyroidectomy regardless of the serum calcium level.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYA questionnaire survey and review of the literature show that pregnancy can be well tolerated in most women with renal transplants. Fifty-two per cent of the renal transplant recipients who became pregnant had full-term infants with no serious complications. With therapeutic abortions excluded, 71% of the 308 pregnancies permitted to continue resulted in full-term infants. Rejection episodes were occasionally a serious problem, occurring in 9% of the pregnancies. Mechanical interference with renal excretion or preventing vaginal delivery occurred in 5.6% of the cases. Hypertension and proteinuria, often existing prior to pregnancy, became frequently increased during pregnancy. Infections not associated with rejection were common but easily controlled in most cases. Prematurity was frequent but related to renal function and the time interval from transplant to conception. The most serious infant complications were related to prematurity. Unknown is the future of these infants and their progeny because of their intrauterine exposure to immunosuppressive drugs.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYBetween January 1,1968 and March 1977, 100 of 131 patients who lost their first transplant at the University of Minnesota received a second renal allograft. Overall patient survival in the retransplanted group was 10% less than that in the dialysis group. The best results (graft function and patient survival) were seen in young patients, nondiabetics, patients who received two sequential living related groups, and in those whose first graft was lost secondary to chronic rejection. The poorest results were seen in older patients (>40 years), diabetics, and patients with acute rejection during the initial graft. Shared donor antigens do not affect graft outcome. These findings, although not the product of a randomized prospective study, may be useful in advising patients of the relative risks of retransplantation or hemodialysis.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYBlood transfusions prior to first cadaver kidney transplants have a significant beneficial effect on graft survival and, in this sense, appear to enhance the possibility of a compatible transplant. This desirable effect, however, occurs concomitantly with an increased degree of sensitization, which in turn reduces the likelihood of identifying a compatible kidney by direct crossmatch testing. This report illustrates that the beneficial effect is achieved with one to five transfusions prior to transplantation, but that more transfusions afford no additional benefits. In addition, the presence of cytotoxic antibodies per se does not have an adverse influence on graft survival. Liberal transfusion policies are therefore indicated in cadaver transplant candidates, but more than five transfusions prior to transplantation should probably be avoided unless clinically necessary.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

SUMMARYThe development of acute graft-versus-host (GVH) disease in (C57BL/Rij X CBA/Rij)F, hybrid mice inoculated with C57BL/Rij spleen cells is associated with a specific antihost delayed-type hypersensitivity (DTH) in the lymphoid organs of these mice. In this paper the role of proliferation in the development of this DTH response was studied in relation to the cellular changes in spleen and lymph nodes during GVH disease.Blocking of DNA synthesis of the C57BL/Rij spleen cells by incubation with 25 /μg of mitomycin C per ml before inoculation into the irradiated recipients did not prevent the antihost DTH responsiveness in the spleen during the first 2 days, and in the lymph nodes at 3 days after reconstitution. Thereafter, the DTH responsiveness was greatly decreased by the mitomycin C treatment. Blocking of both DNA and RNA and a great part of protein synthesis by pretreatment with 100 μg of mitomycin C per ml could completely prevent the development of DTH responsiveness in the recipient mice.Elimination of the DNA synthetizing cells from the recipient's spleen and lymph nodes by tritiated thymidine ([3H]TdR) suicide in vitro revealed that the appearance of antihost DTH responsiveness in both organs is associated with a local proliferation of the reactive T cells. In both the spleen and lymph nodes, elimination of the DNA synthetizing cells at the moment of peak DTH reactivity reduced the DTH response to about 50% of the normal value. This decrease was larger before reaching peak DTH reactivity, whereas thereafter [3H]TdR could no longer affect the height of the antihost DTH response. These results suggest that full development of specific antihost DTH responsiveness during an acute GVH reaction is dependent on proliferation of the reactive T cells.

ISSN:0041-1337    

出版商:OVID    

年代:1979

数据来源: OVID