Search PubMed⌕ Search

Biomedical subjects

C Hiesse

Publications and source records attributed to C Hiesse.

At least 109 records · Page 6Linked to original sources
PubMed1988

Multiple drug combinations with "low-dose" cyclosporin for renal transplantation. Multivariate analysis of risk factors determining short-term graft survival within one renal transplant center.

The factors affecting graft survival in transplant recipients receiving cyclosporin (CsA) are still being debated. Our report is based on an analysis of 202 successive transplantations performed in our institution from May 1984 to December 1986, using low-dose CsA as the basic means of immunosuppression. A total of 142 patients received the triple combination CsA, azathioprine (AZA), and corticosteroids. Sixty patients received a prophylactic combination of CsA, corticosteroids, and antilymphocyte globulins (ALG). From January to December 1986, both regimens were compared in a prospective randomized trial. The factors that affect graft survival were analyzed using the Cox multivariate hazard analysis. The relative risks were calculated for pretransplant baseline risk factors and for outcome-dependent post-transplant risk factors for surviving grafts at 1 month. Transplants performed with a prolonged ischemia time and patients whose graft did not function immediately were statistically at higher risk of graft loss. Adding prophylactic ALG to CsA was associated with better graft survival. Patients who experienced more than 1 rejection crisis and patients whose 1-month CsA dose was lower than or equal to 5 mg/kg per day were also at significantly higher risk of further graft loss. Neither HLA matching, peak panel reactivity, age of the recipient, occurrence of post-transplant renal dysfunction nor 1-month renal function affected the short-term graft outcome.

Adrenal Cortex Hormones↗
PubMed1988

[Treatment of mycotic aneurysms after renal transplantation].

The authors report two cases of aneurysm in renal transplantation: one after removal of the transplant and the other with the transplant in place. In both cases, repair was preceded by excision of the aneurysm and consisted of interposition of an inverted autologous vein graft.

Adult↗
PubMed1987

[Anti-cytomegalovirus T-cell immunity and HLA restriction in the transplanted kidney patient].

Cytomegalovirus (CMV)-specific immune T-cells, present in the circulation of previously infected kidney transplant recipients (anti-CMV serum antibody titer greater than 1/40) can be reactivated to give rise to specific helper and cytotoxic effector cells by co-culturation with fresh autologous blasts coated with CMV antigen in vitro. The reactivated cells are able: 1) to proliferate when stimulated with CMV antigen, 2) to kill the autologous target coated with CMV antigen and not autologous blasts alone when assayed in 51Cr release test. These specific effector cells lie in the E+ T cell subset by removing NK cells with sheep-erythrocytes rosetting. When the reactivated cells are tested against allogeneic CMV coated blasts the level of cytotoxicity is in general related to the extent of HLA-A and B antigen sharing between effector and target cells. The results provide strong evidence that: 1) only previously infected individuals can generate immune T cells against CMV in vitro, 2) there is a correlation between the index of proliferation and cytolysis, 3) there is an HLA restriction of immune T cell cytotoxicity of CMV, 4) monoclonal antibodies directed at several antigenic sites of CMV are able to block cytolysis.

Adolescent↗
PubMed1987

[Demonstration of complex dysregulation of anti-cytomegalovirus T-cellular immunity in Kaposi's sarcoma following renal transplantation].

An increased incidence of Kaposi's sarcoma is well known in renal transplant recipients in whom it may represent up to 3 p. 100 of all de novo tumours. This sarcoma has a close relationship with the potential oncogenicity of the cytomegalovirus (CMV) and with chronic immunological deficiency. Anti-CMV immunity is based on the integrity of cytotoxic cellular functions such as those of cytotoxic T lymphocytes (CTL), "natural killers" cells, and K cells which function in the antibody-dependent cell cytotoxicity (ADCC) system. Two cases of Kaposi's sarcoma were observed out of a total of 700 renal transplant recipients; they underwent the following investigations: lymphocyte sub-group counts by murine monoclonal antibodies, lymphocyte proliferation to lectins and allogenic cells, NK activity and generation of specific auxiliary and cytotoxic anti-CMV cells. Both cases of Kaposi's sarcoma were seropositive for CMV and seronegative for LAV. In one case, an abnormal number of peripheral OKT9 + lymphocytes (normally a thymocytic marker) was observed with small numbers of OKT4/OKT8, a reduced proliferative response to mitogens and allogenic cells. All these in vitro changes persisted despite reduction of immunosuppressive therapy and clinical improvement. A clinical and biological cure was only obtained after withdrawal of immunosuppressive therapy and return to haemodialysis. In the second case of Kaposi's sarcoma, the initial biochemical changes were minimal and a clinical cure was obtained by decreasing the immunosuppressive therapy. These two cases illustrate the complex dysregulation of the immune system in Kaposi's sarcoma.

Adult↗
PubMed1987

[Results of the treatment of renal artery stenosis in transplanted kidneys].

Fifty-six renal artery stenoses involving transplanted kidneys among a series of 819 renal transplants performed from 1978 to 1986 were treated. Forty-two patients underwent surgery. Surgery was the initial treatment in 38 cases and followed failed or complicated dilatation in four cases. Surgical treatment ensured successful control of hypertension in 85% of cases with a mean time lag of 26 months. Recurrence rate was 12%. Two patients died in the perioperative period. Percutaneous dilatation was performed in 18 renal artery stenoses and ensured control of hypertension in 61% of cases with a mean time lag of 19.6 months and a 33% recurrence rate.

Adult↗
PubMed1987

[Results, over a 3-year, period of a triple combination: cyclosporin, azathioprine, prednisolone in high-risk kidney transplants].

A prospective study was conducted on 57 high-risk patients having received cadaver renal transplants between January 1983 and May 1984, and submitted to the triple combination: cyclosporine, azathioprine, and steroids. 23 patients of Group I including 12 pre-sensitized and poorly matched recipients were treated from the Day 1 post-transplant. 34 patients of Group II received the triple combination following a steroid-ALG resistant rejection. Actuarial graft survival in the whole group was 74%, 64%, and 64% at 1, 2, and 3 years respectively. Patient survival was 100% in the Group I, vs 85% at 1 year, and 82% at 2 years in the group II (p less than 0.02). The incidence of infectious complications and infectious deaths was significantly higher in patients of Group II. Our results suggest the effectiveness of a triple low-doses combination in high-risk renal transplantation, but the delayed use of this combination following a treatment with high-doses of steroids and ALG fails to reverse the rejection, with an obvious overimmunosuppression risk.

Adolescent↗
PubMed1987

Confirmation of the interaction between cyclosporine and the calcium channel blocker nicardipine in renal transplant patients.

We report seven cases out of eight reversible raises (350% of mean increase) of cyclosporine (CsA) plasma levels in patients receiving the new calcium channel blocker nicardipine (Loxen-Sandoz) and CsA after renal transplantation. Nicardipine was introduced 3 to 36 weeks post transplantation in 7 cases of hypertension and 1 case of angina pectoris. CsA plasma levels raised considerably 1 to 30 days after nicardipine introduction and returned to pretreatment levels 1 to 7 days after withdrawal. Serum creatinine increased in 1/8 patients. These data suggest that nicardipine interferes with CsA metabolism and this interaction is reversible after nicardipine discontinuation. These findings point out the fact that at least some calcium channel blockers need to be cautiously used in patients receiving CsA.

Adult↗
PubMed1987

[Value of DTPA scintigraphy following furosemide injection in the diagnosis of obstruction in renal transplantation].

Following development of dilatation on ultrasonography and/or intravenous pyelography in the course of follow-up after renal transplantation, a dilatation due to obstruction must be distinguished from dilatation without obstruction. DTPA scintigraphy is frequently used for the diagnosis of hydronephrosis caused by an anomaly of the pyeloureteric junction. In renal transplantation, this examination is used less frequently. The authors report a prospective study of Lasilix scintigraphy in the diagnosis of obstruction in 30 renal transplant. The results presenting with stasis of their transplant. The results were classified into 4 groups according to O'Reilly's classification and were compared with the course of the stasis. Lasilix scintigraphy demonstrated a specificity of 93% and a sensitivity of 63%. The role of stasis in the deterioration of the renal function of a transplant is difficult to evaluate. In cases of stasis with altered renal function, the authors propose the addition of study of the renal parenchyma by renal biopsy, which excludes rejection and Cyclosporin nephrotoxicity. When the renal biopsy is normal, the kidney should be drained by percutaneous nephrostomy which evaluates the capacity of recovery of renal function and determines the indication for antegrade dilatation or surgical repair.

Adult↗
PubMed1987

[Intravenous digital angiography in the kidney transplant patient: results of a systematic prospective study in 164 patients].

A prospective study on digital intravenous angiography (DIVA) in 164 renal transplant recipients performed from 1 to 2 months post-transplant was conducted to assess its usefulness in the screening of post-transplant renal artery stenosis (RAS). DIVA was uninterpretable in 32 patients (19%) on technical grounds (blood vessel or metallic clip superimposed). The global prevalence of RAS was 10.7% in 132 patients whose DIVA was informative. No correlation was found between the prevalence of RAS and renal function. The prevalence of RAS was significantly higher (p less than 0.01) in the hypertensive (26%) than in the normotensive group (6.6%), but RAS may occur in normotensive or even asymptomatic patients. Our data confirm the usefulness of routine post-transplant renal artery screening but arterial way will be preferred.

Adult↗