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Biomedical subjects

D Steinmuller

Publications and source records attributed to D Steinmuller.

At least 73 records · Page 4Linked to original sources
PubMed1982

Improved cadaver allograft survival in transfused recipients who remain serologically negative for cytomegalovirus.

Between April 1976 and October 1979, 100 consecutive cadaver renal transplants were done. Before transplantation 48 recipients were seronegative and 52 were seropositive for cytomegalovirus. After transplantation there were 20 primary and 38 secondary cytomegalovirus infections. The development of post-transplant cytomegalovirus infection, with or without overt symptoms, had no effect on graft survival. The 1-year graft survival was significantly better (p less than 0.05) in high transfused (more than 5 units) recipients (70 per cent) compared to nontransfused recipients (36 per cent). The beneficial effect of transfusions was not diminished in patients with positive post-transplant cytomegalovirus serology. Of the transfused recipients those who remained serologically negative for cytomegalovirus pre-transplant had significantly better 1-year graft survival (78 per cent) than those who were cytomegalovirus positive before transplantation (58 per cent) (p less than 0.05). The improved graft survival in patients who remain cytomegalovirus seronegative after multiple blood transfusions may be a manifestation of unresponsiveness to immunologic as well as virogenetic stimulation.

Adult↗
PubMed1982

Determinants of allograft survival in 100 consecutive cadaver kidney transplants.

We reviewed 100 consecutive cadaver renal transplants done at our clinic between April 1976 and October 1979. A minimum 1-year followup was available on all patients. The actual 1-year graft survival rate was 64 per cent and the actual 1-year patient survival rate was 91 per cent. Criteria that had no significant effect on 1-year allograft survival were performance of pre-transplant nephrectomy and/or splenectomy, red blood cell group or the level of pre-formed antibody. A major determinant of graft survival was the number of blood transfusions received before transplantation. The 1-year graft survival rate was 36 per cent with no pre-transplant transfusions, 64 per cent with 1 to 5 transfusions and 70 per cent with more than 5 transfusions (p less than 0.005). The 1-year graft survival rate was not influenced by the use of kidneys imported from other states, the use of pediatric cadaver donors 1 to 15 years old or extended renal preservation times. Our experience supports continued regional and national sharing of adult and pediatric cadaver donor kidneys with extended preservation times.

Adolescent↗
PubMed1982

Pretransplant donor specific blood transfusions for one haplotype stimulatory mixed lymphocyte culture living related donor transplants.

Three donor specific blood transfusions were given at 2-wk intervals pretransplantation, to those donor-recipient pairs who were one haplotype identical, but had stimulatory MLC. Two of 10 recipients who received donor specific blood transfusions developed T cell cytotoxic antibodies against their donor and were not transplanted. Eight recipients were successfully transplanted with no evidence of hyperacute rejection. All eight grafts are functioning from 2 to 15 mo post-transplant. Serum creatinines range from 1.0--3.9 mg%. There have been five patients who developed acute rejection episodes during the first 5 days post-transplant, and there have been a mean of 2.4 rejection episodes per patient. These results compare favorably to historical controls at the same institution who had a 40% incidence of graft success. The long-term graft survival remains to be elucidated.

Blood Donors↗
PubMed1982

Establishment of cytolytic T lymphocyte clones to epidermal alloantigen Epa-1.

Based on in vivo studies, it has been suggested that the extreme susceptibility of skin to the deleterious effects of transplantation immunity reflects the presence of skin-specific histocompatibility antigens. Immunization of C3H/He mice with purified epidermal cells from H-2-compatible CBA mice leads to the generation of cytolytic T lymphocytes (CTLs) that recognize the epidermal-specific alloantigen Epa-1 in H-2-restricted fashion. In this report we describe four CTL lines that have been maintained in vitro for over 9 months that possess Epa-1 and H-2 restriction specificity identical to that observed in bulk CTL populations, as well as two CTL lines with novel specificities. The predominant cell surface phenotype of all of the CTL lines is Lyt-1-, Lyt-2+, and Thy-1+ as determined by indirect immunofluorescence. We could detect no evidence for overlap between these CTL lines and CTLs mediating lysis of target cells bearing foreign H-2 antigens. From these observations, we conclude that the CTLs in each of these long-term lines represent the progeny of a single clone whose specificity is directed toward tissue-specific alloantigens.

Animals↗
PubMed1982

Long-term results of renal transplantation in recipients with a functioning graft for 2 years.

The late results of renal transplantation are reviewed in 214 recipients with a functioning allograft for 2 years. Graft survival was better (P less than 0.001) in living related recipients (t 1/2 = 17 years) compared with cadaver graft recipients (t 1/2 = 7.7 years). Graft survival was also significantly different (P less than 0.001) in patients with a 2-year serum creatinine level of less than or equal to 2.0 (t 1/2 = 16.4 years), 2.1 to 3.0 (t 1/2 = 6.5 years), or greater than 3.0 mg/dl (t 1/2 = 2.9 years). A greater proportion of patients with a 2-year serum creatinine level of greater than 3 mg/dl had experienced greater than two rejection episodes (P less than 0.0001). Among recipients with a 2-year serum creatinine level of less than or equal to 2.0 mg/dl, living related grafts achieved better graft survival than cadaver grafts (P less than 0.05). Major complications of transplantation were more common in patients with a cadaver graft, 2-year serum creatinine level of greater than 3 mg/dl, or age greater than 45 years. One hundred and forty-two patients are currently alive, 93% of whom have achieved complete rehabilitation.

Adolescent↗
PubMed1981

The role of computerized tomography in renal transplant patients.

We evaluated 53 patients with computerized tomography after renal transplantation. The diagnostic value of computerized tomography scanning was primarily in differentiating between patients with acute rejection and those with obstructive uropathy, urinary fistula or significant perinephric fluid collections. Computerized tomography guidance also may be helpful in performing anterograde pyelography or percutaneous allograft biopsy. The computerized tomography scan provides an effective, non-invasive, complementary method of evaluating post-transplant dysfunction.

Graft Rejection↗
PubMed1981

Management of end stage polycystic kidney disease with renal transplantation.

Thirty renal transplants have been done in 25 patients with end stage polycystic kidney disease. All but 2 allografts were from a cadaver donor and the average followup was 5 plus or minus 0.9 years. THe 1 and 5-year patient survival rates after transplantation were 76 and 50 per cent, respectively, and allograft survival rates were 63.3 and 39.1 per cent at the same intervals. Of 14 patients at risk for more than 8 years 6 still have well functioning allografts. Nine patients underwent transplantation with both polycystic kidneys in situ and with no adverse sequelae resulting from the retained native kidneys. Despite the risk factors inherent in an older than normal population of cadaver allograft recipients, renal transplantation is an excellent method for treating end stage polycystic kidney disease and holds the prospect for long-term allograft and patient survival rates.

Adult↗
PubMed1981

Cell-mediated cytotoxicity to non-MHC alloantigens on mouse epidermal cells. III. Epidermal cell-specific cytotoxic T lymphocytes.

We have previously shown that murine epidermal cells (EC) from 5 H-2 compatible donor strains induce cytotoxic T lymphocytes (CTL) in C3H hosts that preferentially lyse donor EC as opposed to donor lymphoid cells (LC). This preference has been shown to be dependent on a single alloantigen disparity, designated epidermal alloantigen (Epa). In this report we studied the specificity of the CTL to determine whether Epa-antigens are in fact EC specific. Two populations of CTL could be identified by cross-immunization, cold-target inhibition, antigen-driven suicide, and limiting-dilution analyses. A minor CTL population recognizes alloantigens that are expressed by both EC and LC, but this population is necessary only for lysis of LC targets. The major CTL population is specific for Epa-antigens and reacts only with EC targets. At the induction phase of CTL responses, donor LC stimulators can weakly stimulate Epa-specific CTL, indicating LC populations express Epa-antigens in immunogenic form but at very low levels compared with EC. The preferential lysis of EC targets in these strain combinations can be attributed to the major Epa-specific CTL population, whereas lysis of LC targets is due to CTL specific for other alloantigens that are shared by EC and LC. The identification of CTL-activating, EC-specific alloantigens may help to explain the extreme immunogenicity of MHC compatible skin allografts.

Animals↗
PubMed1980

Late ureteral obstruction and hematuria from de novo angiosarcoma in a renal transplant patient.

A patient is described with a long-term functioning renal allograft who presented with ureteral obstruction and hematuria from an angiosarcoma. The diagnosis of ureteral obstruction was established preoperatively with computerized tomography guided anterograde pyelography. This represents the first documented case of an angiosarcoma occurring de novo in a renal allograft recipient. Continued awareness is needed of the increased risk of malignancy following transplantation.

Adult↗
PubMed1980

The older living renal donor: prognosis for the donor and recipient.

Results after 46 renal transplants from living donors more than 50 years old are presented. There were no complications after transperitoneal nephrectomy and renal function remained stable in all donors. The mean followup for transplant recipients was 6.2 years. The 2-year patient and graft survival rates were 76.1 and 60.9 per cent, respectively, while the corresponding 5-year rates were 60.5 and 46.5 per cent, respectively. These results suggest that age per se should not eliminate living related kidney donation.

Age Factors↗
PubMed1980

Results of renal transplantation in children.

From 1968 to 1978, 66 renal transplants were performed on 58 pediatric patients with end stage renal failure. With a mean followup of 6 years 46 patients (79.3 per cent) are alive and 35 (60.3 per cent) currently have a functioning renal allograft. Live donor allografts yielded fewer surgical complications and better long-term functional survival rates than cadaver allografts. Patient rehabilitation following a successful renal transplant was excellent. However, despite resumption of growth in most cases normal linear growth was achieved rarely. Renal transplantation provides the best long-term solution to the problem of end stage renal disease in children.

Adolescent↗