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Biomedical subjects

H Brynger

Publications and source records attributed to H Brynger.

At least 55 records · Page 3Linked to original sources
PubMed1987

Intravascular volumes and colloid dynamics in relation to fluid management in living related kidney donors and recipients.

This study examines our current perioperative fluid regimen in relation to body fluid compartments, intravascular volumes, and early kidney function in 17 kidney transplant recipients and their living related donors. Donors were given 0.5 g/kg of 10% dextran-40 during surgery and electrolyte solutions averaging 3032 ml/24 h. Recipients were randomized to receive albumin or dextran-40 infusions and given 0.5 g/kg during surgery. Electrolyte and 5% glucose infusions averaged 5580 ml/24 h, to match the urinary output. Total intravascular albumin (TIA) and total intravascular dextran (TID) were calculated from the plasma concentrations and plasma volume (PV). Mean preoperative PV in the donors was 44.5 ml/kg. The TIA loss of 0.37 g/kg was balanced by a TID of 0.27 g/kg, and PV increased to 46 and 49 ml/kg at 3 and 34 h after surgery, respectively. In recipients, the preoperative volume of extracellular water correlated linearly to the total body water and PV, as well as to the urine flow the first 24 h after transplantation. No difference was found in urine volume, serum creatinine, or PV expansion between recipient patients receiving albumin or dextran-40. Twelve patients with immediate urinary onset had blood volume (BV) and PV of more than 70 and 45 ml/kg, respectively, in sharp contrast to five patients with delayed urinary onset, who had lower BV and PV values. A fall in TIA of 0.9 g/kg at 3 h corresponded to a PV loss of 18 ml/kg and was only partially replaced by the 0.5 g/kg of intraoperative colloids.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Evidence of donor-specific cellular suppressor activity in donor-specific cell-mediated lympholysis unresponsiveness in renal transplant patients.

Twenty patients with well-functioning kidney grafts from one-haplotype-mismatched related donors, were studied 1-10 years after transplantation (A). Another group of six patients were studied at various times after transplantation (B). The presence of donor-specific transplantation tolerance, using mixed lymphocyte culture (MLC) and cell-mediated lympholysis (CML) tests was investigated, as well as the possible existence of cells with suppressive activity. All recipients were transfused prior to transplantation and treated with conventional immunosuppression. The patients in group A showed MLC reactivity against donor and third-party cells, indicating a allogeneic response capacity. The CML activity against the donor was low, however, and remained low also following removal of adherent cells. The CML activity toward third-party cells was within the normal range of unmatched individuals. In group B, two of six recipients and high postoperative CML activity against the donor. Both recipients showed clinical signs of rejection. In the remaining four recipients, the antidonor CML reactivity one week after transplantation was lower than the preoperative level. The decrease was even more pronounced at 12 months, although the reactivity against third-party cells was unaltered. The CML reactivity from unrelated fourth-party individuals toward donors was suppressed when cells from recipients with long-term functioning kidneys were added to the cell cultures. The results suggest the presence of a donor-specific cellular suppressor mechanism underlying the donor-specific CML unresponsiveness in recipients with long-term-functioning kidney allografts.

Adolescent↗
PubMed1987

Mechanisms maintaining transplantation tolerance in antithymocyte globulin-treated rats.

A model for induction of permanent PVG/c heart allograft survival in adult WKy rats, following antithymocyte globulin (ATG) treatment, was studied. Attempts to induce acute rejection of permanently accepted grafts, by injection of presensitized spleen cells, were successful only if the tolerant recipients had been pretreated with cyclophosphamide. Tolerance against second allografts from the primary donor strain could not be abrogated by injection of presensitized cells shortly after grafting. After removal of the permanently accepted graft, the tolerant recipients regained their capacity for acute rejection within 100 days. Tolerance was adoptively transferred with spleen cells, obtained from tolerant rats, to syngeneic sublethally irradiated recipients. The transferred unresponsiveness was donor-specific, antigen-dependent, and could again be transferred to irradiated recipients. The transferred suppression was abolished by the addition of presensitized, but not by naive, syngeneic spleen cells. The results indicate that donor-specific, antigen-dependent suppressor cells are essential for the maintenance of ATG-induced allograft acceptance. The suppression may influence the generation and activation, as well as the function, of alloreactive cells.

Animals↗
PubMed1987

Morbidity and mortality in diabetic and non-diabetic recipients of living related donor kidneys.

The results of kidney transplantation in juvenile-onset diabetic patients were compared to those of an age-matched control group of non-diabetic patients, all of whom were transplanted with kidneys from living related donors during the period 1977-1982, and managed by the use of conventional immunosuppression. The 5-year actuarial patient and graft survival rates did not differ significantly between the groups: 79% and 68% in diabetic patients and 88% and 72% in non-diabetic patients, respectively. The graft function was stable in both diabetic and non-diabetic patients. Early surgical complications in both groups were few. Peripheral vascular insufficiency leading to amputation occurred only in diabetic patients, while hyperparathyroidism was recorded only in non-diabetic recipients. Primary cytomegalovirus infections were more common in diabetic patients. Providing good graft function was achieved, heart complications were a minor problem in both patient groups. However, cardiovascular complications were a leading cause of death in patients whose graft failed. The initial hospital stay was, on average, one week longer in diabetic patients, but the accumulated hospital stay in the three years following transplant was twice as long (1 month per year) in the diabetic group as in the non-diabetic. Rehabilitation during the last six months of follow-up was good in both groups and about 60% of diabetic and 90% of non-diabetic patients were working full- or part-time. Thus, the prospects for survival and rehabilitation were similar in diabetic and non-diabetic patients in the 5 years following transplant, but at a higher price in diabetes.

Adolescent↗
PubMed1987

No difference in outcome between 314 nontransfused and 614 transfused cadaveric renal transplant recipients: the Scandinavian experience.

Pretransplant blood transfusions had no beneficial effect on the graft survival rate, the rejection frequency, or the quality of graft function in a case material consisting of 928 cadaveric kidney transplant recipients treated with 3 different CsA dose protocols. When younger recipients, PRA-negative recipients, or recipients receiving poorly HLA-matched kidneys were analyzed separately, there was still no transfusion effect. In the most recent series, the one-year graft survival rate was 84% among 164 nontransfused patients, and in 73 nontransfused patients under 50 years of age it was 90%. We conclude that with present day immunosuppressive therapy, based on CsA, there is no case for pretreatment blood transfusions. Indeed, this practice might place the renal transplant patient at a disadvantage.

Blood Transfusion↗