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Biomedical subjects

D Potter

Publications and source records attributed to D Potter.

At least 91 records · Page 5Linked to original sources
PubMed1985

Effect of donor-specific transfusions on renal transplantation in children.

Most family members who are evaluated as kidney donors for children have high reactivity in a mixed lymphocyte culture test and are thus excluded from donation. Fifty children, most of whom had highly reactive mixed lymphocyte cultures with their donors, were challenged with three blood transfusions from their donors before transplantation and were tested for the development of lymphocytotoxic antibodies. Ten children (20%) became sensitized and had a positive T-cell or B-cell crossmatch. Sensitization occurred less frequently in children treated with azathioprine during donor-specific transfusions (11%) than in those not treated (26%), but the difference was not significant. Thirty-seven children received renal transplants from their blood donors after the donor-specific transfusions. There were no deaths, and only two patients had kidney failure. Actuarial kidney survival was 93% after 6 years. The use of donor-specific transfusion has increased the number of related-donor transplants performed and the results have been highly successful.

Actuarial Analysis↗
PubMed1984

Kaposi's sarcoma of the head and neck in the acquired immune deficiency syndrome.

Since 1981 a new syndrome of acquired immune deficiency (AIDS) has been recognized. Male homosexuals, male and female intravenous drug abusers, and recipients of blood products (i.e., hemophiliacs) appear to be the populations at risk. The syndrome has been manifested by community-acquired opportunistic infections and/or Kaposi's sarcoma (KS). Otolaryngologic manifestations of AIDS are not infrequent. Thirteen AIDS patients at the National Institutes of Health with KS of the head and neck region are presented. All 13 patients were homosexual or bisexual males. Nine initially presented with KS, five with KS of the head or neck. As a group the patients demonstrated lesions involving the oropharyngeal, tracheobronchial, and gastrointestinal regions. Their clinical course and complications are presented in detail. The mortality rate in this subgroup of AIDS patients is extraordinarily high (62%), with an average longevity of 11 months following initial diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Continuous ambulatory peritoneal dialysis in children: comparison with hemodialysis.

The clinical and biochemical effects of continuous ambulatory peritoneal dialysis in 20 children and of hemodialysis in 16 children were compared over a 2 1/2-year period. Statistically significant differences between the treatment groups included higher hematocrit, higher serum carbon dioxide and cholesterol levels, large intake of calories and protein, and lower systolic blood pressure and rates of transfusion in the patients receiving continuous ambulatory peritoneal dialysis. These patients had more complications than the patients receiving hemodialysis, but hospitalization rates in the two groups were similar. The cost of continuous ambulatory peritoneal dialysis was +19,600 per patient-year; the cost of hemodialysis was +54,300 per patient-year; the cost of hemodialysis was +54,300 per patient-year. There were four treatment failures with continuous ambulatory peritoneal dialysis and one with hemodialysis. Patients treated with both forms of dialysis preferred continuous ambulatory peritoneal dialysis. We conclude that continuous ambulatory peritoneal dialysis is an important alternative to hemodialysis in children.

Blood Pressure↗
PubMed1982

Microbial mutation studies with tetrachlorvinphos (Gardona)).

The mutagenic activity of tetrachlorvinphos was investigated in agar-layer cultures of Escherichia coli WP2 and WP2 uvrA, Salmonella typhimurium TA1535, TA1538, TA98 and TA100. Assays were carried out both in the presence and in the absence of S9 fractions of liver homogenates from rats and mice, both from untreated animals, and from animals pre-treated with Aroclor 1254. The induction of mitotic gene conversion by tetrachlorvinphos was studied in stationary phase cultures of the yeast Saccharomyces cerevisiae D4. No mutagenic effects, as determined by reverse gene mutation, were detected in vitro in the bacterial/mammalian microsome assay when a range of bacterial tester strains were exposed to tetrachlorvinphos at amounts up to 2000 micrograms per plate, either in the absence or in the presence of S9 fractions from non-induced or Aroclor-induced mouse or rat livers. Tetrachlorvinphos did not increase the mitotic gene conversion frequency in stationary phase cultures of the yeast, Saccharomyces cerevisiae D4.

Animals↗
PubMed1982

Prognostic features of early renal transplant rejections.

In an analysis of 632 cadaver transplants, the early renal transplant course gave important prognostic information depending on temporal and/or renofunctional characteristics of rejection episodes. Two transplant rejections occurring within the first 2 mo posttransplant were associated with either 37%, 27%, or 6% 1-yr graft survivals depending on whether these episodes were separate, temporally back-to-back, or were without interrejection renofunctional recovery, respectively. This compares to 1-yr graft survivals of 89% or 73% in those patients who had no rejection or one with recovery early posttransplant. Patient survival in groups with multiple early rejections was also associated with a poor prognosis. Ninety to 93% 1-yr patient survival was noted when there was no or one rejection. There was only a 74%-83% 1-yr patient survival with two early treated rejections. Transplant rejection therapy must be individualized or even withheld in order to ensure optimum graft and patient survival.

Blood Transfusion↗
PubMed1982

Management of Candida peritonitis with intravenous amphotericin: Peritoneal fluid antibiotic levels.

The child presented in this report received intravenous amphotericin B 0.5 mg/kg every 36 hours, for dialysis-associated Candida peritonitis. Just prior to her third dose of amphotericin B, the peritoneal fluid concentration of this drug was 0.1 mcg/ml, and the simultaneous serum level was 0.2 mcg/ml. An hour following the third amphotericin B dose, the peritoneal fluid and serum concentrations were 0.2 and 0.4 mcg/ml respectively. The minimal inhibitory concentration (MIC) of amphotericin B for the C. albicans isolated from this patient was 0.05 mcg/ml, and the minimal lethal concentration (MLC) was 0.1 mcg/ml. Treatment included concurrent 5-fluorocytosine, and catheter removal. This is the first time that measurements of concentrations of amphotericin B in the peritoneal fluid have been reported in a child with peritonitis.

Amphotericin B↗
PubMed1982

Coccidioidomycosis in renal replacement therapy.

The potential risk of coccidioidomycosis has led to concern about the advisability of maintaining renal transplantation programs in endemic areas. We reviewed the charts of 721 patients undergoing dialysis and 260 renal transplant recipients in Arizona to determine the incidence, risk factors, and clinical course of coccidioidomycosis in these immunosuppressed populations. Symptomatic infection occurred in six (0.83%) patients undergoing dialysis and 18 (6.9%) transplant recipients. Male sex and blood type B predisposed to dissemination. Urine cultures for fungus were important diagnosis aids. Four of six patients with infection limited to the thorax and five of 18 patients with dissemination remained alive after seven months to 7 1/2 years. Although the rate of dissemination (75%) and mortality (63%) from coccidioidomycosis were high, the incidence of infection was low and does not preclude renal transplantation in Arizona. Those who have received transplants elsewhere should be advised not to move or to visit areas endemic for coccidioidomycosis.

ABO Blood-Group System↗
PubMed1981

1,500 renal transplants at one center: evolution of a strategy for optimal success.

From analysis of results of more than 1,500 renal transplants has evolved a plan for donor selection and immunosuppressive management whereby patients with end-stage renal disease can obtain maximum graft and patient survival. With superior results in both patient and graft survival with living-related transplantation, this modality should be considered initially. Pretreatment with third party blood transfusions appears effective in all donor categories. Donor-specific blood transfusions have afforded 1-haplotype mixed lymphocyte culture-incompatible recipients enhanced opportunity for successful transplantation. Current results with living-related transplantation suggest realistic expectations of 1 and 2 year graft survival rates of greater than 90 percent. Curtailment of steroid therapy has resulted in improved patient survival at 1 and 2 years: 98 and 97 percent for recipients of living-related grafts, and 91 and 88 percent for recipients of cadaver grafts. These results, in combination with proper donor selection and appropriate recipient pretreatment with blood transfusions, have made renal transplantation a very effective therapeutic method in patients with end-stage renal disease.

Adolescent↗
PubMed1981

Pretreatment with donor-specific blood transfusions in related recipients with high MLC.

Pretreatment with deliberate DST has not resulted in hyperacute or irreversible rejection in patients receiving kidneys after negative donor-specific crossmatches, but has afforded immunologically disparate related recipients enhanced opportunity at successful transplantation. Additionally, with a post-transplant course paralleling that of HLA-identical siblings, high-dose immunosuppressive therapy for rejection has been spared in many recipients. Transplantation, however, proved unsuccessful in a patient receiving a kidney from his positive B-warm crossmatch blood donor in a protocol departure. This case experience and subsequent antibody studies have reconfirmed our initially established criterion of not proceeding with transplantation against a persistently positive B-warm donor-specific crossmatch. By pursuing the initially established DST protocol, it appears that a potentially unsuccessful living related transplant can be avoided, while the transplants actually performed have enhanced prospects of success. The nature of the various immunologic responses in this patient population remain to be more clearly defined.

Antibody Formation↗
PubMed1980

Deliberate donor-specific blood transfusions prior to living related renal transplantation. A new approach.

In order to select MLC incompatible one-haplotype related donor-recipient pairs that would achieve better graft survival and in an effort to alter the recipient immune response, 45 patients received three fresh blood transfuions from their prospective kidney donors. Recipient sensitization was evaluated by cross-match testing weekly sera obtained during and after the blood transfusions against donor T- and B-lymphocytes at 5 C (cold) and 37 C (warm). Thirteen (29%) of the 45 potential related recipients developed a positive warm T-cell cross-match or a persistent warm B-cell cross-match to their blood donor and related transplantation was not performed. Thirty-two (71%) patients had an appropriate negative cross-match to their blood donor. Thirty of these patients subsequently received kidneys from their blood donor. Ninety-seven per cent of the kidneys are functioning from one to 25 months with a single graft failure due to a patient discontinuing immunosuppressive medication. In addition to the excellent graft survival there was an unusually low incidence of rejection episodes in the recipients of kidneys from their blood donor so that the posttransplant course paralleled that of HLA-identical siblings. This approach may have future application with two-haplotype mismatched donor-recipient pairs, both related and unrelated.

Adult↗
PubMed1979

Analysis of costs and outcomes of renal transplantation at one center. Its implications.

A cost increase of more than 900% for medical services to dialysis patients and transplant recipients has been projected during the decade 1974 to 1984. To evaluate the role of renal transplantation in the End-Stage Renal Disease Program, we analyzed direct costs and patient outcomes in 466 consecutive transplants at our center. A successful transplant from either a living related or cadaver donor cost less than +7,000 per year for two years of graft function. The cost of transplants rejected during the second year also proved cost-effective when compared with the yearly costs of maintenance-facility hemodialysis. Patient survival was 100% at two years for recipients of a transplant from a living related donor and 84% at two years for recipients of a transplant from a cadaver. Renal transplantation can reduce the rising costs for end-stage renal disease patient care, without reducing life expectancy.

Adolescent↗