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Biomedical subjects

G Kootstra

Publications and source records attributed to G Kootstra.

At least 19 recordsLinked to original sources
PubMed1995

Outcome of transplantation of non-heart-beating donor kidneys.

To reduce the shortage of kidneys for transplantation, we started a non-heart-beating (NHB) donor programme, and compared the short-term and long-term outcomes of kidneys from NHB donors with those of a matched group of kidneys from heart-beating (HB) donors. 57 NHB kidneys were procured at the University Hospital in Maastricht and at three regional hospitals in the Netherlands, and were transplanted in 21 transplant centres within the Eurotransplant exchange organisation. 114 matched controls from HB donors were selected from Eurotransplant files. Mean follow-up was 85 months. At 5 years, graft survival was 54% for NHB kidneys and 55% for HB kidneys; patient survival was 75% and 77%. Kidneys from NHB donors had a significantly higher rate of delayed graft function (60% vs 35%), resulting in a longer hospital stay. Primary non-function of the graft was seen as frequently in the NHB donor-kidney group as in the HB group (14% vs 8%, p = 0.3). We conclude that NHB donors are a valuable source of kidneys for transplantation.

Death↗
PubMed1995

Protection of canine renal grafts by renin-angiotensin inhibition through nucleoside transport blockade.

The aims of this study were (1) to investigate the effect of R 75231, a nucleoside transport inhibitor, on renin-angiotensin release after renal ischemia-reperfusion and (2) to establish a possible protective effect of this drug on renal function. We used a canine model for auto- transplantation of kidneys that had been subjected to 30 min of warm ischemia and subsequently to 24h of cold storage in HTK preservation solution, with immediate contralateral nephrectomy. R 75231 was injected intravenously into six dogs in two equal portions of 0.05 mg/kg both 30 min and 10 min before reanastomosis was established. Another six dogs were used as a control group. At 2 weeks post-transplantation, five out of six dogs in the R 75231 group and one out of six in the control group were still alive. Starting on day 4, serum creatinine was lower in the R 75231 group than in the control group (p < 0.005). In contrast to the control group, an inversion of the median preischemia adenosine/inosine ratio was observed in the R 75231 group after reperfusion (0.4 preischemia vs 4.0 after 60 min of reperfusion). Reperfusion of the graft resulted in an immediate increase in renin, angiotensin I, and angiotensin II venous blood levels in the control group. In the R 75231 group, renin, angiotension I, and angiotensin II levels were significantly lower. We conclude that administration of R 75231 before reperfusion has a protective effect on post-transplant function of kidneys that have been subjected to prolonged warm ischemia. This effect may, at least in part, be ascribed to inhibition of the breakdown and disposal of endogenous adenosine which, in turn, inhibits the excessive stimulation of the renin-angiotensin system in the early phase of reperfusion.

Animals↗
PubMed1995

Inhibition of CD18-dependent leukocyte adherence by mAb 6.5 E does not prevent ischemia-reperfusion injury as seen in grafted kidneys.

The present study was designed to determine whether beta-2 integrin-mediated leukocyte adherence to the endothelium is involved in renal ischemia-reperfusion damage and to evaluate the therapeutic intervention potency of monoclonal antibody (mAb) 6.5 E, directed against the leukocyte CD18 adhesion molecule. To answer these questions, we used a clinically relevant canine model for the autotransplantation of kidneys that had been subjected to 30 min of normothermic ischemia, followed by 24 h of cold storage preservation. Intravital fluorescence microscopy of capsular microvessels showed that substantial leukocyte adherence occurred after renal ischemia and reperfusion. Leukocyte adherence was observed in both arterioles and venules, but predominantly in the latter. Reperfusion of the graft resulted in a statistically significant reduction of the venular red blood cell velocity (RBCV). Moreover, the venular diameter increased. No significant changes in the arteriolar RBCV or in the arteriolar diameter were observed. Administration of mAb 6.5 E, 1 h before reperfusion, inhibited leukocyte adherence to the renal microvascular endothelium, resulting in an improved venular flow 2 h after reperfusion. However, we observed no beneficial effect of mAb 6.5 E pretreatment on post-transplant graft function and survival. We conclude that leukocyte adherence does not play a critical role in the development of renal injury following reperfusion of kidneys that have been subjected to prolonged warm and cold ischemia.

Animals↗
PubMed1995

Non-heart-beating donors: methods and techniques.

In light of the shortage of kidneys from HBDs the use of NHBDs can be considered essential. Emergency in situ preservation using a DBTL catheter offers the possibility of procuring kidneys from otherwise unsuitable donors. The procedure requires perfect organization and immediate availability of trained personnel and equipment. A standardized protocol is essential. The procedure is a valuable asset in emergency and transplant surgery.

Death, Sudden, Cardiac↗
PubMed1995

[Ambulatory surgery in the Netherlands].

Day care treatment is encouraged in the Netherlands on the one hand by the government and on the other hand by the request of the patients. There is a continuous shift from clinical to day care cases and through diversification, f.i. 24-hour admittance and short stay, one will be able to further reduce the number of expensive long stay hospital beds.

Adolescent↗
PubMed1995

Survival of arteriovenous fistulas and shunts for haemodialysis.

OBJECTIVE: To formulate a standard for assessing functional patency of vascular access and to present long-term results of vascular access in a group undergoing dialysis, in particular the effects of percutaneous transluminal angioplasty (PTA). DESIGN: Retrospective study 1971-1980, prospective study 1980-1991. SETTING: A unit for haemodialysis in a regional hospital, The Netherlands. SUBJECTS: All 259 patients treated from 1971 to 1991 in a programme for chronic haemodialysis. INTERVENTIONS: All interventions, surgical and radiological, needed to maintain vascular access. MAIN OUTCOME MEASURES: Intervention free periods, patency of access, life expectancy of access, and early failure rate (within 4 days). Patency of access before and after PTA. RESULTS: A total of 1179 interventions were made. 407 Arteriovenous (A-V) fistulas and shunts were constructed, and there were 519 surgical reoperations and 253 PTAs. The secondary cumulative patency rate for the autogenous distal A-V fistulas (Cimino) was 79% at one year, 68% at two years, and 59% at three years. Routine use of PTA from 1986 onwards resulted in a rise in secondary cumulative patency for Cimino A-V fistulas after two years from 65% to 80% (p > 0.05). CONCLUSIONS: To describe and assess vascular access the patency rate alone is not sufficient; intervention free periods and life expectancy must also be given. Routine use of PTA with the Cimino A-V fistula resulted in an appreciable but not significant increase patency at two years.

Adolescent↗
PubMed1994

Nonheart-beating donors: the Maastricht experience.

The growing gap between the number of organs available for transplantation and patients on waiting lists demands additional donor sources. Nonheart-beating (NHB)-donor programs are known to increase the number of kidneys available. The group of potential NHB donors is very diverse and therefore 4 categories have been identified. At the University Hospital Maastricht, a NHB-donor program was implemented in 1980 to harvest kidneys after an in situ perfusion technique. In order to evaluate the function of kidney grafts from NHB donors, a retrospective multicenter study on the NHB-donor kidneys transplanted until 1992 was performed, using a control group of kidneys from heart-beating (HB) donors. The short-term results showed more delayed function (DF) in the NHB-donor group accompanied by higher serum creatinine levels at one-month posttransplant. The long-term outcome, however, was equal in both groups showing similar graft and patient survival rates up to 5 years. Apart from the type of donor, HB or NHB, only the number of HLA-DR mismatches could be identified as a potential risk factor for delayed graft function. NHB donors contribute considerably to reducing the gap between offer and demand in kidney transplantation and transplant centers should include NHB donors in their procurement programs. Meanwhile, efforts should be made to improve the short-term posttransplant graft function. Together with reducing DF, searching for valuable tools in viability assessment should also be an objective. Past viability tests never found broad clinical use but might be important in the optimal and safe usage of the potential NHB donor pool.

Adolescent↗
PubMed1992

The effect of FK506 treatment on pancreaticoduodenal allotransplantation in the primate.

The effect of FK506 monotherapy on pancreaticoduodenal allotransplantation was studied in a primate model. The recipients were made diabetic by total pancreatectomy, thus glycemic control depended on the graft. In control animals hyperglycemia occurred after 14 +/- 3 days and the animals died after 36 +/- 15 days. For FK506-treated animals, the time until development of hyperglycemia was 60 +/- 12 days (P less than 0.05). The animals were then sacrificed by day 90 (P less than 0.05). All three control animals lost their graft function because of severe rejection, as verified by postmortem examination. Only one of the five treated animals showed evidence of a moderate-to-severe rejection at 90 days, one animal having a mild rejection as judged by the histological findings. The drug was clinically well tolerated in all except one animal that became apathetic and refused to eat. Hyperglycemia and an elevated serum creatinine level, which were probably related to the FK506 treatment, occurred in one animal each. Both of these side-effects were reversed by reducing the dose. Thus the use of FK506 permits successful single pancreatic transplantation in primates.

Amylases↗