Biomedical subjects

A Toyotome

Publications and source records attributed to A Toyotome.

3 recordsLinked to original sources

PubMed1989

The transfusion effect.

1. Many transplant centers have apparently abandoned their deliberate transfusion protocols believing that the beneficial effect of transfusions no longer outweighs the risks. 2. Pretransplant blood transfusions have consistently improved graft survival among recipients of first cadaver donor transplants. One-year graft survival rates were 5-8% higher for transfused patients transplanted each year between 1982 and 1987. Transplants performed in 1988 and 1989 showed a 3% improvement with transfusions. 3. Whereas large numbers of transfusions resulted in higher 1-year graft survival rates in the precyclosporine era, 2 or 3 transfusions provided the maximum effect in more recent transplants. 4. A disturbing decrease in the long-term survival of transplants to nontransfused patients and patients given 1-4 transfusions has been noted. Nontransfused recipients transplanted since 1985 had a higher loss rate after the first year than those transplanted prior to 1982. If this trend can be verified as more follow-up becomes available, it suggests that the transfusion effect has become a factor in long-term survival rather than one that affects only the immediate posttransplant period. 5. Transfusions decreased the risk and apparent severity of early rejection episodes. Twenty-six percent of transfused patients had early rejection and 1-year graft survival was 67%. Among nontransfused patients, rejections occurred in 42% and survival was 56%. Patients with no early graft dysfunction had 89% 1-year graft survival when transfused and 83% when not transfused. 6. Transfusions improved 1-year graft survival by 7% for Asian recipients, 6% for Blacks, and 4% for Whites. The improvement within each racial group was significant. 7. Kidneys that were mismatched for HLA-DR antigens and kidneys from donors younger than age 16 had significantly poorer survival when transplanted to nontransfused patients. Transfusions mitigated the effects of mismatching and donor age on 1-year graft survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1987

Early graft function.

1. Most of the first rejections occurred between the first and third weeks after transplantation, with the peak at 7 days. 2. Average serum creatinine values of 2 mg/dl were achieved in 2 days for living-related donor transplants. Cadaver donor grafts reached an average of 4 mg/dl by the tenth day, but in patients without rejection serum creatinine values of almost 2 mg/dl were achieved. 3. Cadaver donor grafts with cold ischemia times less than 12 hours led to the best early serum creatinine values. Cold ischemia times up to 48 hours and possibly beyond led to slightly higher creatinine levels but did not produce damage in proportion to the cold ischemia time. 4. Patients who were sensitized to more than 50% of the panel showed evidence of sensitization by having higher serum creatinine levels from one week to 3 weeks. 5. Even in the first few days after transplantation with a cadaver donor, black recipients had a higher serum creatinine than white recipients. The donor's race did not have a marked effect. 6. CsA doses given to cadaver donor recipients were about 2-4 mg/kg higher than living-related donor transplants. Patients experiencing a rejection episode were found to have been treated with about 1 mg/kg more than those without rejections. The corresponding blood levels of CsA were higher in the cadaver donor grafts and those with rejections. 7. Early serum creatinine levels were very strongly correlated with the one-year graft survival rate. Even one day after transplantation, the difference between patients with the best and worst one-day serum creatinine levels was as much as 30% in the one-year graft survival rate. At 2 weeks, the group with the best serum creatinine had a one-year survival rate that was 50 percentage points higher than the worst creatinine group. At one month, the best serum creatinine group had a one-year survival rate that was about 80 percentage points higher than the worst serum creatinine group. 8. Patients with high CsA levels of over 400 ng/ml in the early one-month posttransplant period, had poorer one-year graft survival than those with lower levels. The optimum level appeared to be less than 100 ng/ml by the tenth day and about 100-200 ng/ml to the third week posttransplant.(ABSTRACT TRUNCATED AT 400 WORDS)

Creatinine↗

PubMed1986

Early graft function.

1. The average serum creatinine level during the first 20 days after transplantation was lower in HLA-identical siblings than in parental donor transplants, suggesting an early effect of histocompatibility. 2. In rather small numbers of patients, the daily average serum creatinine values were not different with HLA-DR mismatching and HLA-B,DR mismatching, but were lower in the better matched transplants for the HLA-A,B loci and the HLA-A,B,DR loci. 3. The average serum creatinine values in the first 20 days after transplantation were correlated with the one-year graft survival rates. Those patients with serum creatinine levels less than 2.4 mg/dl had one-year graft survival rates of over 80% compared with those with serum creatinine levels above 7.5 mg/dl after the first week who had one-year graft survival rates about 30% less. Intermediate serum creatinine values yielded intermediate one-year graft survival rates. 4. The cyclosporine dosage in the first month after transplantation varied considerably among the four centers studied here. These values were not directly correlated with the one-year graft survival rate, average serum creatinine levels or cumulative rejection rates in this preliminary examination. 5. Patients who rejected transplants 11 to 60 days posttransplant had been given lower cyclosporine dosages than those who rejected early or who had no rejections. 6. Although firm conclusions cannot be drawn from the small numbers of patients encompassed in this study, we hope the potential value of this type of analysis will be realized.

Creatinine↗