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H Kreis

Publications and source records attributed to H Kreis.

At least 91 records · Page 5Linked to original sources
PubMed1994

Impact and evolution of peliosis hepatis in renal transplant recipients.

Peliosis hepatis and hepatic sinusoidal dilatations are rare vascular liver diseases that occur at increased frequency in kidney transplant recipients. We retrospectively evaluated in kidney transplant recipients the natural history of vascular liver diseases, their impact on patient and graft survival, and the influence of AZA withdrawal. Between 1970 and 1990, vascular liver disease was diagnosed in 32 cadaver kidney transplant recipients 1-128 months after transplantation (mean 41 months). Diagnosis was based on histology in all cases. Patients received conventional immunosuppression (high dose steroids and AZA). Twenty patients had a minor form (sinusoidal dilatations or focal peliosis), while 12 had a major form (diffuse peliosis) of vascular hepatic disease. Two patients were lost to follow-up and 1 died at the time of diagnosis. In 12 patients (group 1), AZA dosage remained unchanged, while it was interrupted at the time of diagnosis in 17 patients (group 2). Five group 1 patients underwent serial liver biopsies, which showed persistence of vascular hepatic disease in 3 (with regenerative nodular hyperplasia in 1) and disappearance in 2 patients. Eight group 2 patients underwent serial liver biopsies, which showed disappearance of vascular hepatic disease in 6 patients and persistence in 2. Moreover, regenerative nodular hyperplasia was noted in 1 case, perisinusoidal fibrosis in 1 case, and cirrhosis in 6 cases. Three patients of group 1 and 11 patients of group 2 returned to dialysis a mean of 21 and 39 months after diagnosis, respectively. Eight patients died and death was clearly associated with major peliosis in 2 cases. In kidney transplant recipients, vascular hepatic disease may be associated with high mortality, especially in major forms. Our findings indicate that peliosis hepatis may lead to severe fibrosing liver lesions. The course of vascular hepatic disease is not clearly modified by AZA withdrawal.

Adolescent↗
PubMed1994

Peripheral microchimerism in long-term cadaveric-kidney allograft recipients.

Microchimerism after allogeneic organ transplantation may be a mechanism for induction of donor-specific graft acceptance. However, the frequency of chimerism and its relevance in long-term tolerance are uncertain. We studied 15 long-surviving (more than 20 years) cadaveric-kidney transplant recipients for the systemic presence of donor alleles with allele-specific genomic amplification of DRB1 and H-Y loci. Microchimerism was observed in 1 case in peripheral blood and in 4 cases in skin. Chimerism and number of HLA alleles shared by donor and recipient were not correlated. This low frequency of microchimerism in long-term kidney allograft recipients raises doubts about a major participation of chimerism in donor-specific tolerance.

Blood Grouping and Crossmatching↗
PubMed1994

Microchimerism frequency two to thirty years after cadaveric kidney transplantation.

Understanding the mechanisms of unresponsiveness to allograft is crucial in order to induce long-term specific immune tolerance in organ recipients. An association between persistent microchimerism following allogeneic organ transplantation and donor-specific graft acceptance has recently been proposed. However, the frequency of chimerism and its relevance in long-lasting tolerance are still unclear. We studied 12 long-surviving (20-30 years) and eight recently grafted (2 years) cadaveric kidney transplant recipients for the systemic presence of donor alleles by using allele-specific genomic amplification of DRB1 and H-Y loci. This technique enabled the detection of a 1:4000 to 1:10,000 donor-recipient cell ratio. Among long-term tolerant recipients, microchimerism was observed in only one case in the peripheral blood and four cases in the skin. These chimeric patients did not differ from others by any clinical or immunologic parameter. In the 2-year tolerant patient group, skin chimerism was evidenced in only one patient who had simultaneously received kidney and liver transplants. No correlation was observed between the presence of chimerism and the number of HLA-DR alleles shared by donor and recipient. This low frequency of microchimerism raises doubts about a major role of chimerism in development of long-lasting specific tolerance following kidney allografting.

Female↗
PubMed1994

Absence of association between HLA antigens and chronicity of viral hepatitis in haemodialyzed patients.

The role of HLA antigens in the chronicity of viral hepatitis is still being debated. We analyzed the relation between HLA status and viral hepatitis in 558 consecutive haemodialyzed patients who underwent kidney transplantation. HLA A, B, DR status, ABO-Rh blood group, duration of haemodialysis, and number of blood units transfused during the dialysis period were known for all patients. Serological status for hepatitis B virus and hepatitis C virus and results of liver biopsies were available in 495, 300 and 316 patients, respectively. After correction for the number of tests performed, frequencies of HLA antigens did not differ significantly for: 1. hepatitis B virus infection (compared to HBsAg-positive and anti-HBc and/or anti-HBs-positive nonvaccinated patients); 2. hepatitis C virus infection (compared to anti-HCV-negative and -positive patients); 3. histopathological status (compared to patients who had chronic viral hepatitis and those who did not). These results suggest that there is no evidence for a significant role of a particular HLA antigen in the development of chronic viral hepatitis in haemodialysis patients with similar underlying immunosuppression and exposure to infection by hepatotropic viruses.

Adult↗
PubMed1994

Hyperhomocysteinaemia: a significant risk factor for cardiovascular disease in renal transplant recipients.

Moderate hyperhomocysteinaemia has been shown to constitute an independent risk factor for cardiovascular disease (CVD), a frequent cause of morbidity and mortality in renal transplant recipients (RTR). In these patients few data regarding both total homocysteine levels and their influence on cardiovascular risk have been reported. We therefore studied serum homocysteine levels in deep-frozen sera from 42 kidney transplant recipients with a follow-up of 11 +/- 4.5 years (mean +/- SD) after transplantation. Eighteen patients had one or more ischaemic events (CVD (+)) and 24 patients had none (CVD (-)). Serum samples had been drawn 1-6 months prior to the first vascular event in CVD (+) patients and serum storage time was comparable in both CVD (-) and CVD (+) patients. Serum homocysteine levels were measured using a radioenzymatic method. Mean homocysteine level was significantly higher in 42 RTR males and females (15.5 +/- 6.3, 13.5 +/- 5.5 microM respectively) compared with 35 control subjects matched for age and sex (8.7 +/- 1.9, 7.5 +/- 1.9 microM, P < 0.001). The difference in serum homocysteine levels between CVD (+) and CVD (-) RTR nearly reached statistical significance in male patients (18.6 +/- 7.8 versus 13.1 +/- 3.4 microM, P < 0.06) but not in female patients (P = NS). In the CVD (+) group 11/18 patients had homocysteine levels > 14 microM (the upper limit in healthy controls) versus 7/24 in the CVD (-) group (P = 0.04). In these patients we simultaneously measured in the same serum samples, serum triglycerides, and total and HDL cholesterol, and calculated LDL cholesterol. By stepwise discriminant analysis and by logistic regression analysis in this relatively small patient population, only serum triglycerides and homocysteine were selected as risk factors associated with CVD. We conclude that significant hyperhomocysteinaemia is present in renal transplant recipients and represents a potential risk factor for cardiovascular disease in these patients.

Adult↗
PubMed1994

Effectiveness of adenine arabinoside 5'-monophosphate in kidney transplant recipients with chronic active hepatitis B.

Hepatitis B virus infection is responsible for both morbidity and mortality in kidney transplant recipients. Adenine arabinoside 5'-monophosphate (ARA-AMP), a synthetic purine nucleotide with anti-viral activity, leads to a sustained interruption of HBV replication in approximately 40% of immunocompetent patients. We report the results of a pilot study using ARA-AMP to treat HBV-related chronic active hepatitis in kidney transplant recipients. Ten patients (2 females and 8 males, mean age 44 years, mean time post-transplantation 163 months) received a 28-day course of ARA-AMP intramuscularly: 5 mg/kg twice daily for the first 5 days during hospitalization and subsequently 5 mg/kg once daily at home for the remaining 23 days. Mean follow-up was 18 months, ranging from 7 to 28 months. All patients but one had biopsy-proven chronic hepatitis, including five cases of cirrhosis. All patients had been chronic HBs Ag carriers for more than 1 year and had active replication as assessed by the presence of serum HBV DNA (mean titre, 270 pg/ml, ranging from 12 to 997 pg/ml, Genostics method). HBe Ag was present in 7 of the 10 patients. Pretreatment creatinine was normal. In four of the 10 patients, HBV DNA became undetectable respectively 1, 1, 5, and 11 months after beginning ARA-AMP. In five patients, HBV DNA decreased during ARA-AMP therapy but subsequently increased although no change was noted during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Imaging of vascular complications of renal transplantation].

The accuracy of color Doppler US (CDUS) for the detection of main renal transplant artery stenoses is excellent (Se 92%; SP 99%). Whereas the sensitivity of CDUS is still unsatisfactory for the detection of arterial branch stenosis (Se 70%), it has become higher than previously reported because of the ability of color flow images to identify hemodynamic changes at the site of stenosis and focal downstream repercussions in the case of tight stenosis. Color Doppler US is a valuable method in the detection of segmental infarction or large areas of cortical necrosis. However, small superficial cortical perfusion defects are usually undetectable by color Doppler. Contrast-enhanced MRI appears to be more accurate than color Doppler US; it is useful in confirming the diagnosis of infarction and detecting small infarcts missed by color Doppler US, and provides an accurate evaluation of the extent of the infarct; Spectral features (reflux during the whole diastole) obtained from renal arteries in case of acute renal vein thrombosis are suggestive but not specific since they can be observed in the case of severe acute rejection with cortical necrosis. Such findings associated with a lack of venous Doppler signals in the whole kidney are highly suggestive of renal transplant vein thrombosis. Post-biopsy arteriovenous fistulas and false arterial aneurysms are accurately detected by color Doppler Imaging. Color Doppler appears to be the primary Imaging modality for early detection of renal allograft vascular complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm↗
PubMed1993

Acyclovir in preventing cytomegalovirus infection in kidney transplant recipients: a case-controlled study.

High dose oral acyclovir has been reported to be effective in preventing both cytomegalovirus (CMV) infection and disease in renal transplant recipients. We conducted a case-controlled study in which 42 cadaveric kidney transplant recipients were prophylactically treated with high dose oral acyclovir for 3 months and compared to historical controls matched for donor/recipient CMV serological status, age, sex, and immunosuppressive therapy. Before transplantation, study group patients received acyclovir intravenously (500 mg/m2 over 1 hour) which was subsequently given orally (basal dose--800 mg four times daily) from day 2 post-transplantation according to renal function. All patients received 14-day induction immunosuppressive therapy with either a polyclonal or a monoclonal antibody together with low dose steroids and azathioprine, cyclosporin being introduced at day 10 post-transplantation. Blood viral cultures as well as CMV antibody titers were performed in study group and control patients in the same laboratory, before transplantation, weekly until 3 months and then monthly until 6 months. CMV infection was defined as a positive blood or bronchoalveolar lavage viral culture or presence of CMV IgM or CMV IgG in a previously seronegative patient. Diagnosis of CMV disease also required the presence of at least one concomitant febrile illness, with or without other clinical symptoms, not attributable to another pathogen. All patients were followed for 3 months. Incidence of both CMV infection and disease was compared in the two groups using the log-rank test. With regard to CMV infection, we found significantly less CMV infection in CMV seropositive patients (regardless of donor CMV serological status) in the study group compared to historical controls (P = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Acyclovir↗