ISSN:1087-2418    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Kidney transplants from unrelated living donors have become an important option during the past few years. A compilation of unrelated donor transplantations performed in the United States by 97 centers showed a 3-year graft survival of 85% for 368 spousal donor transplants and 81% for 129 other unrelated donor transplants, which was similar to the 82% 3-year graft survival for 3368 parental donor transplants. Mortality among living donors was 0.03% in patients who received transplants both before and after 1987. It appears that transplants from spousal and other living-unrelated donors will provide a major new source of kidneys and are associated with excellent early outcomes.

ISSN:1087-2418    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Renal transplantation has matured over the past nearly half-century to become an accepted means of treating end-stage renal disease. Despite innovations in surgical technique and organ preservation, immunosuppressive therapy continues to be the limiting factor in the long-term survival of renal allografts. Some controversy still exists regarding the need for induction protocols in clinical renal transplantation, and even more so as to the optimal means for induction. Since its advent in the early 1980s, most of the maintenance immunosuppressive regimens have revolved around the cornerstone of cyclosporine. New agents recently approved for clinical use and those currently in development may be in a position to replace older agents (for example, tacrolimus [FK506] in place of cyclosporine, mycophenolate mofetil for azathioprine). Unlike cyclosporine, some of these agents (eg, tacrolimus, mycophenolate mofetil, and a new parenteral agent 15. deoxyspergualin) have the added advantage that they are effective in reversing ongoing (and sometimes even steroid-resistant) episodes of acute rejection. To show clinical superiority, however, these new agents will have to demonstrate clinical utility for prevention of chronic rejection, the major limiting factor in long-term renal allograft survival. New clinical regimens employing early protocol biopsies to predict which patients are at risk for chronic renal allograft rejection may allow some of the newer agents to be tested in clinical trials in a prospective, randomized manner. Regardless of their clinical utility, however, the current financial climate may dictate that the ultimate fate of many of these newer agents will depend on pharmacoeconomic considerations.

ISSN:1087-2418    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The use of pulsatile preservation for cadaveric renal allografts is becoming the focus of renewed interest. This is related partially to the perception that pulsatile perfusion can provide a better-quality organ, with a consistently low incidence of delayed graft function, and partially to its ability to allow assessment of a given organ to decide whether it can be transplanted. Pulsatile preservation is also associated with superior outcomes compared with simple cold storage in kidneys with prolonged preservation times, especially in those preserved for more than 24 hours. Newer preservation solutions, in conjunction with pulsatile preservation, can lead to even lower rates of delayed graft function when compared with older solutions. Although it is initially more expensive than simple cold storage, pulsatile preservation can decrease the cost of the initial hospitalization by reducing the incidence of delayed graft function and thus decrease the overall costs of transplantation. In the current era of transplantation, pulsatile preservation is a tempting alternative to simple cold storage and may be the preferred method of preservation of the cadaveric renal allograft.

ISSN:1087-2418    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

With the tremendous growth of solid organ transplantation over the past 30 years, a great deal has been learned about the significance of cytomegalovirus. Much knowledge regarding the epidemiology, pathogenesis, and diagnosis of cytomegalovirus infection has come from experience with renal transplants, which account for the largest number of solid organ transplantation procedures performed. Cytomegalovirus disease is clearly one of the most important infectious causes of morbidity and mortality in this population. The devastating effects of established cytomegalovirus disease have been ameliorated by effective antiviral treatment with ganciclovir therapy. The continued high incidence of cytomegalovirus infection, combined with the cost of treating cytomegalovirus disease, both in terms of patient well-being and financial issues, has stimulated great interest in the development of effective prophylactic and preemptive regimens. Philosophy regarding the best means of prevention varies. Prophylactic strategies provide therapy for all patients who are designated to be at risk for cytomegalovirus disease. These patients are usually stratified according to cytomegalovirus serologic status. Preemptive strategies provide preventative therapy selectively. Preemptive therapy is administered only when there is evidence for asymptomatic infection by established surveillance criteria (ie, positive cytomegalovirus cultures, positive antigenemia assays, or recent seroconversion). Unfortunately, the terms prophylaxis and preemptive are used loosely, which can lead to confusion when reviewing the literature. This overview focuses on pertinent issues regarding cytomegalovirus in renal transplantation and the various strategies for prophylaxis and preemptive therapy. The approach to cytomegalovirus prophylaxis among renal transplant centers varies widely. Often a specific approach within a given center is inconsistent, poorly documented, and based on anecdotal experience. Although the literature is replete with studies using single-agent or combination therapy, they are usually single-center studies of a relatively small number of patients. Large randomized prospective studies are unfortunately few in number. Hopefully, after reviewing the available data, it will be possible to propose an ideal strategy that is both cost-effective and maximally therapeutic.

ISSN:1087-2418    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Optimal growth and development in children with end-stage renal disease is widely believed to be attainable only by successful renal transplantation. This major tenet has been the basis for promoting renal transplantation at the earliest possible time. However, despite the achievement of high allograft survival rates even in younger children and infants, normalization of growth and development have not been realized. This is largely because of the side effects of standard immunosup-pression regimens, which include growth retardation and nephrotoxicity. Although the latter problem is potentially remediable by the use of recombinant human growth hormone, the application of such therapy in the posttransplantation period is limited due to concerns over increased rates of rejection, decreased renal function, and graft loss. Newer immunosup-pressive strategies include use of alternate-day corticosteroids or tacrolimus without long-term use of corticosteroids. Such regimens offer the promise of excellent graft survival, improved growth, and a marked reduction of other adverse effects, which may compromise compliance and overall psycho-social adjustment of children following successful renal transplantation.

ISSN:1087-2418    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1087-2418    

出版商:OVID    

年代:1996

数据来源: OVID