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Biomedical subjects

H Kreis

Publications and source records attributed to H Kreis.

At least 127 records · Page 7Linked to original sources
PubMed1991

MR imaging of renal transplant rejection.

The results of 62 consecutive MR examinations were correlated with the subsequent clinical course and histologic results. Twenty-six cases of rejection showed a marked diminution of cortico-medullary differentiation (CMD). The renal parenchymal vascular pattern and visibility of renal sinus fat were not markedly altered in rejection and there was no difference between normal and rejected allograft shape. The ability of MR imaging to diagnose renal transplant rejection is only based on CMD, which, however, is non-specific. In 2 cases of severe acute rejection, T2 weighted images showed an abnormal signal intensity of the cortex due to renal infarction. Our preliminary results in 8 patients with Gd-DOTA injection showed 2 cases with necrosis seen as areas with absent contrast enhancement. This technique seems to be promising in the detection of perfusion defects.

Adult↗
PubMed1990

Chronic hepatitis in kidney allograft recipients.

98 HBsAg-positive and 31 HBsAg-negative kidney recipients were compared to assess the effect of renal transplantation on chronic liver disease and vice versa. Diagnosis was based on analysis of liver biopsy specimens including semiquantitative evaluation of histological features of chronic hepatitis. Serial specimens were examined: chronic liver disease occurred in 88% of HBsAg-positive patients and 4% of HBsAg-negative patients with normal liver at the time of transplantation. Liver abnormalities in the former were chronic persistent hepatitis (32%), chronic active hepatitis (51%), and cirrhosis (17%). Actuarial patient survival was similar in HBsAg-positive (78%) and HBsAg-negative (87%) patients, as was allograft survival (64% and 71%, respectively). In both HBsAg-positive and HBsAg-negative patients chronic alcohol consumption was more frequent in those with chronic liver disease than those without. These data suggest that renal transplantation may be appropriate for haemodialysis patients with chronic hepatitis whatever their HBV status.

Actuarial Analysis↗
PubMed1990

Detection of anti-listeriolysin O for serodiagnosis of human listeriosis.

To see whether detection of antibodies against listeriolysin O (LLO) could be used to diagnose human listeriosis, sera from 28 patients infected with Listeria monocytogenes and 101 controls were tested by dot-blot titration with purified LLO. 27 patients (96.4%) with listeriosis produced specific anti-LLO. Anti-LLO was detected in 8 (15.6%) of 51 healthy controls and in 6 (12.0%) of 50 controls who had various bacterial, fungal, and viral infections. Anti-LLO titres did not exceed 100 in these two control groups. Anti-LLO could be detected soon after clinical onset of listeriosis, and antibodies persisted for at least several months. This test might be useful for epidemiological surveys and for serodiagnosis of listeriosis, especially when bacteria cannot be isolated.

Adolescent↗
PubMed1990

Genetic basis of nonresponse to hepatitis B vaccine in hemodialyzed patients.

Genetic factors are implicated in the response of normal subjects to hepatitis B vaccine. The aim of our study was to investigate if HLA Class I and II proteins could participate in a nonresponse to this vaccine in immunocompromised, namely hemodialyzed, patients. One hundred and seven hemodialyzed patients (68 men and 39 women, mean age 35 years) were vaccinated with Pasteur Hevac B vaccine, with a mean delay of 2 months following the onset of chronic hemodialysis. Patients were considered nonresponders when their serum antiHBs remained less than 10 mUI/ml on at least two occasions within the 12 months following the vaccination. HLA-A, B and DR antigens were determined by complement-dependent microlymphotoxicity. Ninety patients (84%) were responders and 17 (16%) nonresponders. The HLA-A1, B8 and DR3 frequency was higher in nonresponders (35, 35 and 44%, respectively) than in responders (18, 4 and 14%, respectively). The extended haplotype HLA-A1, B8, DR3 was more frequent in the former (19%) than in the latter (2%) (p less than 0.03). There was only one female within the nonresponders (6%) as compared to 37 (41%) in the responders (p less than 0.05). We conclude that genetic determinants (sex and HLA markers) play a critical role in the induction of an antiHBs immune response in both immunoincompetent hemodialyzed patients and normal immunocompetent hosts.

Adolescent↗
PubMed1990

In vivo cell activation following OKT3 administration. Systemic cytokine release and modulation by corticosteroids.

A massive and self-limited release of tumor necrosis factor and interferon gamma was detected in the systemic circulation in 35 consecutive renal allograft recipients by specific radioimmunoassays very soon following the first injection of the monoclonal antibody OKT3 (anti-CD3). Peak serum TNF and IFN gamma levels were reached, respectively, at 1 and 4 hr following the first OKT3 injection. Abnormally high serum interleukin 2 levels were also observed 4 hr following the first OKT3 injection in a minority of patients (5 cases). OKT3 had no effect on interleukin 1 beta, interferon alpha, and granulocyte/macrophage colony stimulating factor serum levels, which in all patients remained within the normal range throughout the study. This selective OKT3-induced cytokine release, which only followed the first injection, was transient (i.e., lasting a few hours). It tightly paralleled the spontaneously reversible clinical syndrome characterized by high fever, headaches, and gastrointestinal symptoms that is invariably associated with the first OKT3 administration. Importantly, when administered in adequate dosages and with adequate timing, corticosteroids influenced both the cytokine release and the systemic reaction. Thus, the highest TNF, IFN gamma, and IL-2 serum levels were detected in patients who did not receive corticosteroids. Patients who received high-dose corticosteroids (1 g solumedrol bolus) concomitantly with the first OKT3 injection still had high TNF and IFN gamma levels. Conversely, when the same corticosteroid dose was injected 15-60 min prior to the first OKT3 injection, in all cases the increase of serum TNF and IFN gamma was significantly lower as compared with the above-described groups; IL-2 levels did not rise. These data offer a direct explanation for one major side effect of OKT3 and thus provide the basis for devising means to prevent its occurrence.

Antibodies, Monoclonal↗
PubMed1990

Reversal effects of topical retinoic acid on the skin of kidney transplant recipients under systemic corticotherapy.

The systemic long-term corticosteroid treatment administered to kidney graft recipients (KGR) within the framework of the required immunosuppressive therapy induces an atrophy of the skin, from the sixth month onwards. We studied the effect of topical all-trans retinoic acid (0.05%; Galderma Labs.) applied to the forearms of 27 KGR (14 men, 13 women) over a 6-month period. Twenty-four subjects completed the trial. The following results were obtained in the treated forearm versus the untreated forearm (excipient alone): clinically, an increase in skin thickness; by noninvasive techniques, an increase in skin thickness, skin elasticity, skin conductance, and TEWL, and a reduction in the size of the corneocytes. No change in stratum corneum lipid content was observed. A sex-related difference was noted in the response to treatment under our experimental conditions, the female patients responding better. A punch biopsy (4 mm) was performed on both forearms of four patients after the 6-month period. Histologic and ultrastructural examination revealed epidermal and dermal changes evoking increased cellular metabolism in the retinoic acid-treated forearms.

Administration, Topical↗
PubMed1990

The OKT3 immunosuppressive effect. In situ antigenic modulation of human graft-infiltrating T cells.

OKT3 exerts its in vivo immunosuppressive effects by inducing major peripheral T cell depletion as well as antigenic modulation of the T3/Ti T cell receptor complex. Modulated cells, which reversibly lose the expression of the CD3 T cell receptor molecular complex but still share the CD4 and CD8 antigens, have been shown to be functionally immunoincompetent. Antigenic modulation is maintained as long as significant OKT3 serum levels are present. Cells infiltrating renal allografts from seven OKT3 treated patients were studied by double immunofluorescence to assess whether antigenic modulation could affect cells located in profound organs such as renal allografts. Needle biopsies were obtained in patients given OKT3 (5 mg/day) for at least 10 consecutive days in association with conventional immunosuppressive drugs for treatment of a rejection episode (5 cases) or prophylactically (2 cases). In all patients at the time of biopsy, CD3 positive cells were absent from the circulation, significant OKT3 serum levels were present, and neither IgG nor IgM anti-OKT3 antibodies were detected. Infiltrating cells were double-labeled using a combination of either anti-CD3 and anti-CD4 or anti-CD3 and anti-CD8 monoclonal antibodies. Following 7-14 consecutive days of treatment, all patients given OKT3 for a rejection episode showed a significant decrease in the number of graft-infiltrating lymphocytes. Importantly, all T cells still infiltrating the allograft were CD3-CD4+ or CD3-CD8+ cells, which is exactly the same phenotypical pattern of CD3 circulating modulated T cells. In 6 out of the 7 patients, this phenotypical pattern was associated with clinically normal graft function. These results further underline the fact that antigenic modulation is an important mechanism mediating the immunosuppressive effect of OKT3 both in peripheral blood and in renal allografts.

Antibodies, Monoclonal↗
PubMed1989

Hypertension in kidney transplantation.

The prevalence of hypertension is approximately 50 percent in renal transplanted patients, even in the most recent series. Hypertension contributes to the cardiovascular complication observed in these patients. Hypertension is related to various mechanisms: renin release from the own remaining kidney(s), stenosis of the transplant artery, often chronic rejection, rarely recurrence of the initial disease on the renal graft, or possibly transmission of "predisposition" to essential hypertension with the graft.

Humans↗
PubMed1989

IgG rheumatoid factor in human and rabbit transplantation sera.

Sera of human recipients of kidney allografts and rabbit recipients of skin allografts were tested by means of enzyme immunoassays (EIA) for IgG rheumatoid factor (RF) combining with human IgG (RF-H) or rabbit IgG (RF-R). In humans, the mean OD value in EIA for RF-H was significantly higher in 185 sera of allograft recipients than in 46 pretransplantation sera and 100 sera of normal subjects. Furthermore, the mean OD in patients who rejected their grafts was higher than in patients with satisfactory graft function. Interestingly, there was no difference in OD values for RF-R between sera of graft recipients and sera of normal subjects. Of 52 rabbit recipients of skin allografts, 24 were positive for both RF-R and RF-H, 4 were positive only for RF-R, another 4 only for RF-H, and 20 were negative for both. Renal allografts originating from the previous donors of skin grafts resulted, in most instances, in a significant decrease in the strength of the reaction for both RF-R and RF-H. The possible role of graft rejection in stimulation of RF formation as well as the possible role of RF in graft rejection should be considered.

Animals↗
PubMed1988

Granulocyte-associated immunoglobulins in renal transplant recipients with cytomegalovirus infection.

Cytomegalovirus (CMV) infections in renal transplant recipients must be diagnosed rapidly, since they can be life-threatening unless chemotherapy is started early. Detection of granulocyte-associated immunoglobulins was compared with conventional virological methods for diagnosis of CMV infection in 71 renal transplant recipients. The granulocyte-associated immunoglobulin test (GAIT) was positive in 31 of 34 patients with proven CMV infections on the day of admission. By conventional virological criteria the diagnosis of active CMV infection could be made only 3-24 days later. The GAIT remained negative in 14 healthy transplant recipients, but it was positive in 9 of 23 patients with non-CMV-related post-transplantation complications. The GAIT, which is not a virological method, could be useful for rapid diagnosis of CMV infection; its sensitivity was 0.91 and specificity 0.82 (for patients without detectable immunoglobulins on erythrocytes or platelets) and the processing time is only 3 h.

Adult↗