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Biomedical subjects

G Mourad

Publications and source records attributed to G Mourad.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Prognostic factors of success in renal transplantation].

From January 1984 to January 1989, 139 kidneys were retrieved from 74 brain dead donors in our institution. The transplantation was performed either locally (79), or in an other French institution (40). The five year actuarial survival rate, for the 139 kidneys retrieved in Montpellier, was 65 percent. Many factors about the donor, the retrieval and the recipient, which may affect the graft survival, were entered in a Cox multivariate analysis. The minimal follow up duration was 18 months. The risk factors studied included: donor parameters (age, sex, cause of death, haemodynamic parameters and renal function); retrieval parameters (kidney alone or multiorgan harvesting, discoloration and renal perfusion quality); organ characteristics (multiple arteries and cold ischemia time); recipients parameters (age, sex, prior transplantation, local transplantation or not, and HLA matching). A first multivariate analysis included only pretransplant risk factors. The risk factors for graft loss, as identified by the Cox model, were in the order: donor's age (P = 0.03), arterial pressure (P = 0.01), prior transplantation of the recipient (P = 0.01) and kidney discoloration quality during the retrieval (P = 0.008). Early post transplant parameters were included within this Cox model (poor early renal function, need for dialysis, serum creatinine level at one week). The need for dialysis therefore was identified as the main predictive value (P = 0.002). The 4 other risk factors, selectioned in the first model, always remained significant.

Actuarial Analysis↗
PubMed1991

[Coronary ischemia after kidney transplantation in patients over 60 years of age].

Many elderly patients (aged over 60) are waiting for renal allograft but are considered a risk population for myocardial infarction or sudden cardiac death. Between 1987 and January 1st, 1990, 22 elderly patients (16 men and 6 women; mean age 63.4 +/- 0.7 years; range 60-69 years) underwent cadaveric kidney transplantation. Twenty patients had been on haemodialysis for 4.8 +/- 1 years (range: 1-16.3), one had been on peritoneal dialysis for 5 years and one had developed chronic rejection of a previous cadaveric allograft. Among these 22 patients, 6 (27 percent) developed antibodies directed against the random lymphocyte panel and one had a second transplant. Cardiovascular risk factors were systematically estimated, including medical history, cervical arterial Doppler, echocardiography and stress thallium testing (STT). Coronary angiography was performed if there was evidence of myocardial ischaemia. STT did not show any coronary disease in 16 patients and was not maximal (less than 60 percent of maximal theoretical stress) in 4 patients. In 2 patients, STT showed myocardial ischaemia: one, with a history of angina, underwent coronary angiography and angioplasty; the other had silent ischaemia and refused coronary angiography. Two patients died of myocardial infarction. One of them was the patient with silent ischaemia and positive STT test. The patient with angioplasty had a successful transplantation 20 months later, without any cardiovascular complication. After 9 to 32 months of follow-up, 19 patients have functioning allografts (mean serum creatinine level 151 +/- 6 mumol/l). One patient lost his kidney from urinary fistula. Eight patients (36 percent) developed acute rejection and all responded to intravenous corticosteroids. No immunological transplant loss was observed. After 18 months, the graft actuarial survival rate was 85 percent. We conclude that elderly patients free of clinical or silent myocardial ischaemia are good transplant recipients. The cardiovascular risk could be prevented by using STT during the pretransplant screening. If the STT is not maximal or shows coronary ischaemia, coronary angiography is mandatory.

Actuarial Analysis↗
PubMed1991

[Functional reversibility of chronic cyclosporine nephrotoxicity in patients after kidney transplantation].

The long term use of cyclosporin in renal transplant recipients may be complicated by chronic nephrotoxicity, evidenced by renal functional deterioration and suggestive histological lesions. In 11 renal transplant recipients treated with cyclosporin since 28 +/- 5.8 months, we reduced (n = 6) or stopped (n = 5) this drug after chronic nephrotoxicity was diagnosed. Five months later, we conducted hemodynamic studies and observed significant increases in renal plasma flow (I131 hippuran clearance from 239.5 +/- 106 to 327 +/- 50 ml/min/1.73 m2) and glomerular filtration rate (DTPA-TC clearance from 43 +/- 15 to 67 +/- 10 ml/min/1.73 m2) and a decrease in renal vascular resistances. We suggest that cyclosporin-associated chronic nephrotoxicity is accompanied by some degree of reversible vasoconstriction, or that histological lesions, particularly cyclosporin arteriolopathy, can disappear after cyclosporin withdrawal.

Chronic Disease↗
PubMed1991

[Pathogenesis of amyloidosis: a role for anti-proteases?].

A new type of amyloidosis has been observed which appears in long-term survivors on haemodialysis, with beta 2-microglobulin identified as its major protein constituent. We recently identified alpha 2-macroglobulin, the major serum anti-protease, in amyloid deposits of haemodialysis patients. It has also been reported that amyloid fibrils can be redissolved in vitro by proteases. These findings, coupled with the facts that alpha 2-macroglobulin blocks the proteases and decreases macrophage production of proteases, suggest that alpha 2-macroglobulin may prevent the degradation of the amyloidogenic protein allowing amyloid deposit formation and/or persistence. In our opinion, alpha 2-macroglobulin and possibly other antiproteases as well, may play a key role in amyloidogenesis in dialysis patients.

Amyloid↗
PubMed1991

[Dilated cardiomyopathy during post-partum hemolytic and uremic syndrome (HUS)].

A 24-year-old woman presented a severe HUS followed 3 months later by a cardiac failure diagnosed echographically as a dilated cardiomyopathy. The patient was hemodialysed and successfully transplanted. Later course of dilated cardiomyopathy was favourable. Review of literature confirms the rare and severe nature of cardiac lesions occurring in the course of HUS. We suggest a related pathophysiology concerning these two entities.

Adult↗
PubMed1991

[Importance of anti-idiotype antibodies in candidates for a renal graft].

Anti-idiotypes antibodies neutralize, some T lymphocytes clones, others cytotoxic antibodies carrying corresponding idiotypes. Anti-idiotypes antibodies are found in about 45% of patients with chronic renal failure which have received blood transfusions. Some antibodies favourize the kidney graft tolerance, others at the contrary augment the rejection reaction. It is possible to detect antibodies which protect graft by relatively simple and rapid technics. This research merits to be added to the classic cross match. When donor and recipient study reveals a positive cross match with an ancient serum and a negative cross match with an actual serum, the absence of protective antibodies is a contra-indication for kidney graft, but their presence authorize the transplantation.

Histocompatibility Testing↗
PubMed1990

A study of beta 2-microglobulin skin deposits in dialyzed patients and healthy controls.

This study reports on beta 2-microglobulin (beta 2M) deposits in the skin of 12 uremic patients and three kidney transplant recipients compared with eight healthy controls. Uremic patients were treated by hemodialysis (HD), hemofiltration (HF), hemodiafiltration (HDF), or continuous ambulatory peritoneal dialysis (CAPD) for a period lasting from 1 to 19 years. Congo red staining of the skin was negative in patients and controls. However, immunofluorescent staining with an anti-beta 2-microglobulin monoclonal antibody was positive in the skin of all patients and of six of the eight controls. Beta 2M skin deposition is more intense in patients than in controls and increases with patient age and the duration of dialysis. A stron correlation is observed between the extent of skin beta 2M deposits and clinical manifestations due to beta 2M deposits in internal organs. However, no correlation is found between beta 2M skin deposits and sex or beta 2M serum levels.

Adult↗
PubMed1990

[Cytomegalovirus chorioretinitis: unusual and severe complications in renal transplantation. Importance of early diagnosis and prolonged treatment with DHPG].

We report here an observation of severe chorio-retinitis in a kidney transplant patient presenting with a primary cytomegalovirus infection. This complication occurred three months after transplantation, following an aggressive treatment for an acute rejection episode (OKT3 associated with methylprednisolone bolus). The clinical manifestation was blurred vision without other evidence of viral infection. A rapid diagnosis of chorio-retinitis was achieved based on ophtalmoscopic findings and biological results. A prolonged treatment with DHPG was effective in halting the very progression involving the left macula and the righ peripheral retina.

Adult↗
PubMed1990

The renin-angiotensin system and renal function in kidney transplantation.

The use of converting enzyme inhibitors (CEI) has permitted us to assess the role of the renin-angiotensin system in the control of arterial pressure and renal function in various conditions. In renal transplant recipients treated by azathioprine and steroids, the occurrence of CEI-induced deterioration of renal function is highly suggestive of renal artery stenosis, whereas renal vasodilatation associated with unchanged glomerular filtration rate in response to CEI is indicative of a significant role of native kidneys. In hypertensive recipients without renal artery stenosis, the absence of renal hemodynamic changes after CEI may be predictive of subsequent chronic rejection. The information provided by CEI is rather different in cyclosporine treated subjects. In this setting, no acute effect of CEI on renal hemodynamics is detectable. Whether the renal response to CEI is similar in cyclosporine when compared to conventionally treated patients with renal artery stenosis remains to be demonstrated.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

High-molecular-mass proteins in haemodialysis-associated amyloidosis.

1. Protein constituents were determined in eight amyloid deposits from eight patients (five male and three female), 53 +/- 4 years of age, treated by haemodialysis for 9-20 years using only cuprophane membranes and operated for carpal tunnel syndrome. 2. Soluble proteins were removed by solubilization in phosphate-buffered saline after osmotic lysis. The proteins of the insoluble fibrils were characterized by sodium dodecyl sulphate/polyacrylamide-gel electrophoresis and two-dimensional gel electrophoresis, and immunologically identified by Western blotting. 3. In addition to beta 2-microglobulin, alpha 2-macroglobulin was identified in the fibrillar material. The presence of these two proteins in amyloid deposits was confirmed by immunofluorescent microscopic studies. 4. Our data confirm the presence of beta 2-microglobulin in haemodialysis-associated amyloidosis, and also suggest a possible role for alpha 2-microglobulin: it may protect beta 2-microglobulin from proteolytic digestion, leading to its accumulation in intact form and to amyloid fibril formation.

Amyloid↗