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Biomedical subjects

B Berg

Publications and source records attributed to B Berg.

At least 91 records · Page 5Linked to original sources
PubMed1980

Experience with pancreatic transplantation in Stockholm.

Eight attempts at segmental pancreatic transplantation were made in 6 diabetic patients. While the indications for transplantation differed all the patients were severely incapacitated by the disease. None was uremic. The body and tail of the pancreas from cadaveric donors was used, the grafts were revascularized to the recipient's iliac vessles. Six of the grafts provided control of blood glucose for 7-51 days. Five of the grafts then failed owing to rejection, and one had to be removed while still functioning, because of arterial bleeding. Important lessons have been learned concerning both surgical and immunological aspects of this form of treatment : 1) Ducto-jejunostomy should be used to provide exocrine pancreatic drainage. 2) HLA-DR typing for donor-recipient selection and thoracic-duct drainage as an adjunctive immunosuppressive measure should be used to reduce the incidence of graft rejection. 3) An elevation of the postprandial blood glucose concentration is a first sign of rejection and should cause treatment. 4) Graft rejection can be reversed by conventional steroid medication.

Adult↗
PubMed1980

Segmental pancreatic transplantation with duct ligation or drainage to a jejunal Roux-en-Y loop in nonuremic diabetic patients.

The results of seven segmental pancreas transplantations in diabetic patients, using a jejunal Roux-en-Y loop for drainage of digestive enzymes, are presented. An initial case with pancreatic duct ligation is also included. The patients ranged in age from 30 to 45 yr, with duration of diabetes from 8 to 24 yr, and were incapacitated but not uremic. Immunosuppression was attempted with azathioprine, prednisone, and antilymphocyte globulin, and, in one patient, thoracic duct drainage was added. The pancreas tolerated at least 16 min of warm ischemia and at least 4 h of cold storage; flushing with a balanced electrolyte solution was optimal. Six of the grafts provided control of blood glucose for 7--51 days, and, in one patient, an intravenous glucose tolerance test was normal at 7 and 21 days. Five of the grafts failed due to rejection 7--51 days after transplantation, and one was removed at 14 days, while still functioning, due to bleeding. In one case, early detection of rejection by a rise in post-prandial blood glucose was treated and reversed by corticosteroid administration. Two failed in the immediate postoperative period from vascular thrombosis. Drainage of pancreatic secretions from a fistula was a common problem.

Adult↗
PubMed1980

The implications of HLA-DR match for the outcome of cadaveric renal transplantation.

Typing for HLA-DR has been performed in cadaver renal transplantations in Stockholm since 1977, but there was no donor-recipient selection based on HLA-DR. During the period 1977-78 76 cadaver renal transplantations were carried out; in 61 of them typing for HLA-DR was performed. There were 4 exclusions, 2 because of a hyperacute rejection of the graft and 2 because the kidney never started to function after the operation owing to irreversible ischemic damage. In 29 of the 57 transplantations remaining for analysis there was one antigen common to the donor and the recipients, and in 28 there was no common antigen; there was no instance of 2 common antigens. The distribution by degree of HLA-A, -B match was the same for the two groups. Graft survival after one year was better for the group with one common HLA-DR antigen, but the difference was not statistically significant.

Graft Survival↗
PubMed1980

The significance of HLA-A, -B matching for the survival of cadaveric kidney transplants performed in Stockholm in 1970-78.

Of the 320 cadaveric renal transplantations carried out between 1970 and 1978 in Stockholm 308 were analysed with respect to dependence of graft survival on HLA-A, -B matching. From November, 1973, kidneys with 3 or 4 HLA-A, -B incompatibilities were accepted much more often than had previously been the case. All but 7 of the 90 grafts with 3 or 4 incompatibilities were transplanted during that period. In order to obtain as homogeneous a group as possible the transplantations performed during this period were analysed separately, and transplantation performed on diabetic patients and retransplantations were excluded. This material comprising 141 transplantations was examined also with respect to other factors that may have a bearing on graft survival. As regards the factors mean age, pre-transplantation dialysis and blood transfusions, primary diuresis at transplantation and high-dose ALG therapy there was no essential difference between the recipients of kidneys from donors with 1 or 2 HLA-A, -B incompatibilities and the 3 or 4 incompatibility group. Thirteen of the 141 transplantations were fully compatible but because this group was small it was not included in the statistical analysis. After 2 years the group with 3 or 4 HLA-A, -B incompatibilities displayed a significantly poorer graft survival than the one with 1 or 2 incompatibilities (p less than 0.05).

Graft Survival↗