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Biomedical subjects

H Wilms

Publications and source records attributed to H Wilms.

At least 73 records · Page 4Linked to original sources
PubMed1983

HLA-DR-MT matching improves graft survival rate in cadaver kidney transplantation. A prospective multicenter analysis of the South German Cooperative Study Group for Kidney Transplantation.

The influence of prospective HLA-DR matching on the graft survival rate was investigated in a multicenter analysis of 85 transplants. Simultaneously in a retrospective analysis of graft outcome the importance of matching for MT-antigens MT1, MT2 and MT3 as a newly defined B-cell alloantigen system was evaluated. HLA-DR antigens and MT-specificities were determined on B-cells enriched by nylon-wool filtration using locally well characterised HLA-DR antisera and the antiserum set of the 8th International Histocompatibility Workshop ("disease set") which allowed the definition of the HLA-DR specificities HLA-DR 1-9 and of the MT-antigens MT1-3. HLA-DR matching showed a significantly improved graft outcome only in HLA-DR identical donor-recipient combinations. In 11 of 60 patients with one HLA-DR compatibility additional matching for two MT-antigens, however, improved the two year graft survival rate from 60% to 91%. Altogether 17 patients were matched for two MT-specificities with their kidney donor and showed a superior prognosis of 94% at two years compared to 53% or 17% of recipients with one or zero MT compatibility. Graft outcome in this patient group was also superior to that of HLA-DR identical or HLA-AB identical grafts. These data suggested that the MT-system rather than the HLA-DR antigens may be of critical importance in cadaver kidney transplantation. In addition a favorable influence of pretransplant blood transfusions on less HLA-DR matched grafts was confirmed.

B-Lymphocytes↗
PubMed1983

[Function study of the peritoneovenous shunt system].

In patients with otherwise therapy-resistant ascites operative methods for reinstillation of ascitic fluid have gained importance in recent years. Most often peritoneovenous shunt systems in the modification "LeVeen" or "Denver" are set in. Clinical evidence for insufficiency of the shunt system can force the radiologist to check the function of the drainage system. The investigation has to be performed under sterile conditions on the fluoroscope table, thus permitting the angiographic assessment of thrombotic complications as well as check of the position and function of the shunt valve and drainage tubes.

Adult↗
PubMed1983

Influence of Lewis and other blood group systems in kidney transplantation.

In 167 first cadaver kidney recipients and their donors the blood groups ABO, Rhesus, Lewis, MN, Ss, P, Kell and Duffy were determined. The influence of incompatibility in each system as well as of simultaneous presence of several mismatches was analysed. Whereas one-year graft survival of Lewis-compatible grafts was 67 per cent (p = 0.02). The other blood groups showed no significant effect on graft outcome. Cumulative red cell incompatibilities, however, led to decreased survival rates. One-year graft survival in the group with greater than or equal to 4 incompatibilities was only 51 per cent versus 69 per cent in transplants with less than 4 incompatibilities (18% difference, p less than 0.01). When the Lewis system was excluded from analysis, the difference in survival rates was reduced to only six per cent. These data indicate that cumulative incompatibilities of red cell antigens have an unfavourable effect on graft survival. Of the different blood groups, the Lewis system is of major importance.

Blood Group Antigens↗
PubMed1983

Effect of plasma protein binding, volume of distribution and molecular weight on the fraction of drugs eliminated by hemodialysis.

The correlation between plasma protein binding, the volume of distribution, molecular weight, and percentage removed by hemodialysis was investigated in 89 drugs using information available in the literature. The correlation was significantly linear between dialyzability and plasma protein binding, as well as with the reciprocal volume of distribution. This is in agreement with the theoretical deduction of dialyzability from diffusion and convection kinetics. Multiple linear regression analysis revealed that only 27% of the variance in dialyzability could be explained by plasma protein binding (17%), the volume of distribution (6%), and the molecular weight (4%) of the drugs. Therefore, the dialyzability of drugs can not be predicted reliably.

Blood Proteins↗
PubMed1982

[Results of continuous permanent irrigation in diffuse purulent peritonitis].

In a prospective study continuous peritoneal lavage was carried out in 30 patients with diffuse purulent or fecal peritonitis using a volume of 20-50 1/24 h during 5-7 days. Bacteria were recognised in the effusate until day 5. Protein losses per 24 hours amounted to 4,1-46 g. A mean value of 14,5 +/- 14 g was determined. The fractional protein clearance of IgG had increased compared to other proteins. A mortality of 26,7% was obtained. Death causes were the consequences of septic shock. In none of the investigated cases remaining empyemas in the peritoneal cavity could be shown. There was no support for the establishment of lavage tracks.

Adolescent↗
PubMed1980

[Renocortical oxygen supply after kidney transplantation. Renocortical oxygen supply and kidney circulation after autologous kidney transplantation in the dog; its value for human kidney transplantation].

Determination of the viability of a transplanted kidney is still an unsolved problem. Apart from immunological effects hemodynamic and microcirculatory changes in the kidney are important. Thus in 39 mongrel dogs renal floow flow (electromagnetic and local renocortical oxygen supply) and microcirculation (by meaning local tissue pO2) were determined before nephrectomy, immediately after revascularization and before sacrification in experiments with autologous transplantation. Whole kidney blood flow decreased by 30-40%. Measurements of tissue pO2 revealed distinct changes in renocortical oxygen supply. Graft function concomitantly was reduced. Hypotension during revascularization is followed by a strong decrease in renal blood flow and renocortical oxygen supply. Even short periods of hypotension should be avoided.

Animals↗
PubMed1980

[Increased success rate of renal transplantation by HLA-DR-typing: a retrospective analysis of the South-German co-operative study group for renal transplantation (author's transl)].

Retrospective HLA-DR-typing and the influence of HLA-DR antigen on transplantation prognosis was studied in 90 kidney donor-recipient pairs. It was clearly demonstrated that HLA-DR compatible donor kidney provides a significantly better transplant prognosis than if there is HLA-DR incompatibility. Donor kidneys with only one identical HLA-DR antigen gave a six-month survival rate of 80%. Only HLA-AB identical cadaver kidneys ("full house identity") give similar survival times. Because of relatively lower polymorphism of the HLA-DR alloantigen system, HLA-DR identical donor organs are discovered more frequently than when HLA-AB antigens are taken into consideration. HLA-DR identical donor kidneys (identical for both HLA-DR antigens) have an even better transplant prognosis than "full house identical" kidneys, since the survival rate in the former is 87% after six months.

HLA Antigens↗
PubMed1978

[In vivo determination of local tissue pO2 in renal cortex in kidney transplantation].

From measurement of local tissue PO2 in human kidney grafts after restoration of renal circulation, a correlation between initial microcirculation and kidney function can be drawn. PO2-histograms of kidney grafts with sufficient function are normal, whereas PO2-histograms of kidneys with delayed onset of function (congruent to 3 weeks) show distinct disturbances of microcirculation. These preliminary results suggest that measuring local tissue PO2 in transplanted kidneys may be of value for the prognosis of the graft.

Humans↗
PubMed1977

[Complications and lethality after kidney grafts (author's transl)].

Similarly good survival rates were obtained in 113 patients with kidneys transplanted from deceased persons as with patients on home dialysis. The retrospective study showed that fatal complications were not predominantly caused by septic diseases running fateful courses under immunosuppression, but by risk factors which were not recognized soon enough or were incorrectly treated. In our opinion, with careful preparation and supervision of these patients, even in the still unsatisfactory state of immunosuppressive therapy, the possibility exists of carrying out renal grafting without increased risk of mortality compared with dialysis treatment.

Adolescent↗
PubMed1977

[Management of ureteral stenoses and urinary fistulas following kidney transplantation].

The treatment of strictures and fistulas at the lower ureter after kidney transplantation was simple and could be achieved by reimplantation into the bladder. Proximal urinary fistulas caused early abdominal symptoms. The i.v. urogram showed a dilated renal pelvis without drainage into the ureter. The anatomical findings were in all cases strictures or total obstruction of the ureter beneath the pelvic junction and a rupture of the renal pelvis or calix. Adequate therapy consisted of ureteroureterostomy with the recipient ureter and nephrostomy splintage.

Adult↗
PubMed1975

[Postanastomotic renal-artery stenosis after renal transplantation].

A particular kind of renal-artery stenosis was observed in three of 60 renal transplantations performed between 1969 and 1974. It was always 1.0-1.5 cm distal to the anastomosis and, as histological examination demonstrated, was definitely due to vessel injury after removal of the transplant. To avoid it the proximal arterial stump should be cut off before transplantation. The postanastomotic region must be dissected free during the operation and an extended graft venoplasty or sleeve resection performed.

Adult↗