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Biomedical subjects

G Kootstra

Publications and source records attributed to G Kootstra.

At least 217 records · Page 12Linked to original sources
PubMed1980

Non-heartbeating donors, is it worthwhile?

In view of the shortage of cadaveric organ donors a retrospective study has been performed to determine the results of transplantation of non-heartbeating donor kidneys. Graft and patient survival and renal function in the 60 cases analysed in this study, showed no adverse effect of the use of non-heartbeating donor kidneys. The initial graft function was best after in situ cooling of the kidneys, using an intra-aortic double balloon catheter, followed by machine preservation. It is concluded that nephrectomy of non-heartbeating donors is worthwhile and that these donors should be included in all organ harvesting programmes.

Cadaver↗
PubMed1980

The Bishop-Koop anastomosis-a find in pediatric surgery.

A technique of intestinal anastomosis, developed for the treatment of meconium ileus, was used by the authors in the treatment of neonates suffering from various other intestinal anomalies such as atresia, volvulus and apple-peel syndrome. This technique was used in 6 neonates to make a safe intestinal reconstruction.

Female↗
PubMed1979

Cadaveric kidney retransplantation, is it justified?

Results of 44 second cadaveric kidney transplantations are reported and compared with the results of 149 primary cadaveric transplantations. No difference in patient survival is observed. Patients with a non-immunological first graft failure (NIF) had a better two year second graft survival (60%) when compared with patients with an immunological first graft failure (IF) (20%). This difference was not due to a higher degree of presensitisation in the IF group. The use of scarce cadaveric kidneys for retransplantation in patients whose first graft was rejected is considered questionable.

Adult↗
PubMed1979

Venous hypertension of the hand caused by subcutaneous arteriovenous fistulae established for hemodialysis.

Side-to-side arteriovenous fistulae established in patients on chronic intermittent hemodialysis can cause venous hypertension. This gives rise to pain, pigmentation and trophic ulcers. Four patients with these complications are described. In three patients, with a fistula between the radial artery and the cephalic vein, the thumb and the second and third fingers were affected. In the fourth patient, with a fistula between the ulnar artery and the basilic vein, the fourth and fifth fingers were involved. This finding suggests segmental venous drainage of the hand. All patients were cured by ligation of the distal vein. An end-of-vein-to-side-of-artery fistula does not cause the complication described, and for this reason is to be preferred.

Arteriovenous Shunt, Surgical↗
PubMed1978

Pediatric cadaver kidneys for transplantation.

A group of 24 kidneys from donors ranging in age from 1 1/2 to 10 years were transplanted singly into adults and were compared to a group of 44 adult cadaveric kidneys transplanted into adults. There were no vascular complications in either group. There were two urological complications in the 24 pediatric donor cases and none with the adult donor cases. During the first month after transplantation, the mean creatinine clearance was lower in the pediatric donor group; later the function of the pediatric donor kidneys was at least as good as the function of the adult donor grafts. In the group of pediatric donor kidneys, the outcome using kidneys from donors younger than 3 years of age was less satisfactory than for donors 3 to 10 years of age. These data suggest that transplantation of a single pediatric kidney into an adult, particularly if the pediatric donor is at least 3 years of age, will provide satisfactory renal function.

Adult↗
PubMed1978

Machine perfusion versus cold storage for preservation of kidneys before transplantation.

Machine preservation was introduced into the Groningen Transplant Group in December 1972. Thirty five of the 90 kidneys transplanted in the following period of four years were preserved on a machine. The other kidneys were preserved by the so-called cold storage method. The advantages and disadvantages of both methods are outlined. Evidence is found in the literature and in this study that cold storage is sufficient for preservation-times up to 24 hours. When the preservation time exceeds this period, then machine preservation may be an advantage. Kidneys damaged by ischaemia were found to have a higher percentage of immediate function when preserved by the machine compared to those preserved by cold storage. There was no significant difference in one-year graft survival for the kidneys preserved by either method. Machine preservation helps to select between viable and non-viable kidneys from non-heartbeating donors. This is especially important in view of the lack of kidneys for transplantation. Therefore, in the opinion of the authors, it is necessary to continue with machine preservation in selected centres and to make the facilities of these centres available to every donor hospital in The Netherlands.

Animals↗
PubMed1976

Femoral shaft fracture with injury of the superficial femoral artery in civilian accidents.

Eight patients with a fracture of the shaft of the femur and a concomitant lesion of the superficial femoral artery are presented. Six patients had a viable leg; one patient, a below knee amputation, and one, an above knee amputation. Early recognition of this relatively rare combination is of paramount importance. In our experience, internal fixation of the fracture followed by grafting of the artery through separate incision works best.

Accidents, Traffic↗
PubMedDate not supplied

Potential of repairing ischemically damaged kidneys ex vivo.

Therapies that would accelerate recovery from ischemic injury could positively impact the number of kidneys procured from non-heart-beating donors. An acellular warm (32 degrees C) perfusion was used to deliver growth factors to canine kidneys damaged by 2 hours of warm ischemia. Fibroblast growth factors 1 and 2 were selected for activation of the tyrosine kinases because of their known receptor-specific binding in the kidney, metabolic regulation, and mitogenic effect. During 24 hours of ex vivo perfusion at near-normothermia, oxidative metabolism was sufficiently restored to the ischemically damaged tissue to support upregulation of cellular processes dependent on new synthesis. The junctional integrity protein, ZO-1 was used to determine recovery of cytoskeletal integrity. The upregulation of proliferating cell nuclear antigen was used as a marker for recovery of synthetic functions. This modulation of both injury and repair proteins in the damaged kidneys was dependent on new synthesis. The observed modulation resulting in normalization of the cytoskeletal integrity correlated with outcomes in that when the "repaired" kidneys were reimplanted, they provided life-sustaining function. In contrast, when warm ischemically damaged control kidneys without treatment, with subsequent hypothermic perfusion or warm perfused in the absence of growth factors, were reimplanted the result was nonviability. The results of this study suggest that the administration of growth factors during 24 hours of near-normothermic, acellular perfusion, in the absence of concordant inflammation, triggers pathways for new synthesis leading to cellular recovery rather than resulting in cell death.

Animals↗
PubMedDate not supplied

I: Negative effect of cold ischemia on initial renal function.

Correlation between post-transplant function and exposure to cold ischemia (CI) during preservation has been reported. We attempted to identify the effect of CI on renal function using exsanguinous metabolic support (EMS) technology, to eliminate effects of reperfusion complications. Small bovine kidneys were used to evaluate 4 vs. 24 hours of CI, after warm ischemic (WI) exposure of <15, 30 or 60 minutes. After CI, kidneys were warm perfused (30 degrees C to 32 degrees C) ex vivo using EMS technology. Restored renal metabolism and function were quantified by oxygen consumption, urine production, glomerular filtration rate (GFR), and hemodynamic characteristics. The results demonstrate a CI-associated lag phase in the restoration of metabolism, in which the longer cold-preserved kidneys exhibit a lower initial rate of oxygen consumption. However, after 3 hours of EMS perfusion there was no significant difference in the O2 consumed, urine flow, GFR, perfusion flow, or pressure between the kidneys stored for 4 or 24 hours. An initial reduction in metabolism after longer CI may influence the severity of actual reperfusion injury during transplantation. Therefore, these results provide preliminary evidence suggesting that an acellular warm temperature reperfusion ex vivo may enhance restoration of cellular metabolism and minimize damage from the cold seen upon actual reperfusion.

Animals↗
PubMedDate not supplied

II: Ex vivo viability testing of kidneys after postmortem warm ischemia.

Future approaches to expand the organ donor pool with marginal and nonheartbeating donors, will be dependent upon prospective organ evaluation. Restoration of metabolism by preservation at warmer temperatures could potentially provide the window for such evaluation. Using a small bovine model, kidneys were subjected to either < 15, < 30 or < 60 minutes of warm ischemia (WI) followed by cold ischemia (CI) in ViaSpan. After WI and CI, kidneys were transitioned to a warm temperature perfusion (30 degrees C to 32 degrees C) using exsanguinous metabolic support (EMS) technology. Restored renal metabolism and function was assessed by oxygen consumption, glucose consumption, urine production, glomerular filtration rate, and hemodynamic characteristics. The results of this study suggest that it is feasible to distinguish viable from nonviable organs ex vivo by assessing renal metabolism and function during warm preservation using EMS technology.

Animals↗