Significance of Lewis and HLA system in kidney transplantation: a multicenter study in Germany.
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Biomedical subjects
Publications and source records attributed to F W Albert.
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Retrospective HLA-DR-typing and the influence of HLA-DR antigen on transplantation prognosis was studied in 90 kidney donor-recipient pairs. It was clearly demonstrated that HLA-DR compatible donor kidney provides a significantly better transplant prognosis than if there is HLA-DR incompatibility. Donor kidneys with only one identical HLA-DR antigen gave a six-month survival rate of 80%. Only HLA-AB identical cadaver kidneys ("full house identity") give similar survival times. Because of relatively lower polymorphism of the HLA-DR alloantigen system, HLA-DR identical donor organs are discovered more frequently than when HLA-AB antigens are taken into consideration. HLA-DR identical donor kidneys (identical for both HLA-DR antigens) have an even better transplant prognosis than "full house identical" kidneys, since the survival rate in the former is 87% after six months.
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The 'e antigen' (eAg) is specifically associated with hepatitis B virus infections and appears to be a marker for the infectivity and a prognostic indicator of the chronicity of liver disease. Therefore we examined by immunodiffusion the presence of eAg in the seum of HBsAg-positive patients on maintenance dialysis. The dialysis patients had a significantly higher incidence of positive eAg compared with a group of unselected HBsAg-positive patients without renal failure. In most of the dialysis patients the microscopic findings in the liver revealed only 'minimal changes'. Three eAg-positive patients received a renal transplant. Afterwards they displayed an appreciably increased eAg-yield on immunodiffusion and histology revealed chronic persistent hepatitis. It is assumed therefore that the immunodeficiency of patients undergoing chronic haemodialysis is possibly a supporting factor in the synthesis of eAg, and will perhaps induce a more subscute and prolonged course of hepatitis. The synthesis of eAg after renal transplantation may be enhanced by the additional immunosuppressive therapy.
We examined the possibility that haemoperfusion with coated activated charcoal might be used in the therapy of alkyl phosphate intoxications. The criterion used was the effect of haemoperfusion on the elimination of alkyl phosphates from the blood. Clearance values for haemoperfusion of nitrostigmine, demeton-S-methyl sulfoxide and dimethoate were determined in vitro. Very good clearance values were ascertained at a blood flow rate of 100ml/min (mitrostigmine 59.20ml/min, demeton-S-methyl sulfoxide 83.70 ml/min, dimethoate 87.84 ml/min). Measurements of the nitrostigmine clearance as a function of various nitrostigmine concentrations in plasma showed that haemoperfusion is effective over a concentration range covering two powers of ten. A 7-h haemoperfusion with coated activated charcoal was performed on a suicide patient with severe nitrostigmine intoxication (Folidol-öl). Clearance values were obtained which were to be expected on the basis of the in vitro investigations. The nitrostigmine concentrations in the extracorporeal blood plasma fell as a result of haemoperfusion to a mid-value of 55 per cent of the initial level. In the patient the level of nitrostigmine in the blood rose showing that there had been a redistribution of nitrostigmine from the tissue or a subsequent absorption from the gastrointestinal tract into the vessels. The results support the use of haemoperfusion with coated activated charcoal in very severe cases of alkyl phosphate intoxication or where standard therapy fails.
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An abnormal fibrinogen was identified in a man with suspicious prolonged prothrombin time and a mild bleeding tendency. Coagulation studies showed marked prolonged thrombin and reptilase clotting times and a discrepancy between functional fibrinogen test and fibrinogen antigen. The rate of fibrinopeptide B release by thrombin was slightly delayed while the release of fibrinopeptide A was only half the normal amount. DNA sequencing revealed a heterozygous C to T point mutation in position 1202 of exon 2 of the Aalpha chain, resulting in the substitution of Arg-->Cys at position 16, the thrombin cleavage site. This mutation was found also in his 2 children. Both had a mild bleeding tendency too.