Biomedical subjects
Publications and source records attributed to J Ahonen.
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We have investigated the impact of triple drug immunosuppression on the occurrence of early inflammatory episodes, as detected by fine needle aspiration biopsy, and of episodes of clinical rejection during the immediate postoperative period. The prospective component of this study includes 128 consecutive first cadaveric renal transplant recipients receiving triple drug treatment consisting of azathioprine (Aza), cyclosporin (CyA) and methylprednisolone (MP). For controls we have used three historical groups: one immunosuppressed with Aza and MP (group A), another with CyA monotherapy (group B), and the third with CyA together with MP (group C) in equivalent drug dosages. On the average, 0.8 episodes of inflammation per patient were recorded during the immediate postoperative period of 30 days with triple drug treatment. This was significantly less than the 1.3 episodes in patients receiving Aza and MP (P less than 0.01), the 1.7 episodes in patients on CyA monotherapy (P less than 0.001), or the 1.6 episodes in patients receiving CyA together with MP (P less than 0.001). Although the first episode of inflammation commenced concurrently in each group and the peak intensity of inflammation was the same, the mean duration of inflammation was significantly shorter--2.7 days--under triple drug treatment than the 7.8-11.7 days for controls (P less than 0.001). The frequency of rejection episodes under triple treatment was also significantly lower--0.2 per patient--than the 0.8 per patient in controls (P less than 0.001). The first rejection episode occurred later in the triple drug treatment group--on the average, on day 15.2--than in the historical controls (on days 7.7-11.7).(ABSTRACT TRUNCATED AT 250 WORDS)
A prospective randomized study was conducted to evaluate the impact of four different conversion protocols on graft outcome in long-term follow-up. Between January 1986 and May 1987, 128 patients with first cadaveric kidney allografts were randomized at the time of transplantation to four treatment groups of 32 patients each, to be assigned 10 weeks post-transplantation. During the first 10 weeks, all patients received triple therapy with low-dose azathioprine (Aza), cyclosporin (CyA), and methylprednisolone (MP). After 10 weeks, one group continued with triple therapy (group A) while the three other groups received different combinations of two drugs, namely, Aza and CyA (group B), Aza and MP (group C), or CyA and MP (group D). Withdrawal of MP (group B) or especially of CyA (group C) was associated with 4/29 (14%) and 10/28 (36%) acute rejection episodes, respectively, for 60 days after conversion. All rejections were mild and reversible. There were no rejections after Aza withdrawal or in the group that continued on triple therapy during the corresponding time period. The most common reason for dropping out after withdrawal, for those patients who could not continue on the originally randomized medication, was azathioprine intolerance (n = 12). Five patients were switched back to triple therapy after CyA withdrawal due to rejection. Steroid intolerance was rare and CyA in low doses was very well tolerated. At 1 year there were no statistically significant differences in graft survival between groups A, B, C, and D--81%, 88%, 88%, and 88%, respectively--or in patient survival--88%, 88%, 88%, and 97%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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In countries with active renal transplant programs and wide acceptance criteria for transplant patients, the number of cadaveric donors is not, and probably never will be, sufficient to meet the demand for renal allografts. In general between 15 and 20 cadaveric donors PMP per year (maximum 23.7 in Denmark in 1986) have been available in the Scandinavian countries in the 1980s. In most other countries fewer donors are available, but there are regions where higher figures have been reached. Continuous registrations of potential cadaveric donors in Sweden have shown that the number of donors could increase by 40% to 60% if relatives of all medically suitable patients had given consent to organ donation. Since a public survey has shown that factual information on cadaveric organ donation and transplantation had a positive effect on the public's attitude, more public awareness programs are needed. Donor acceptance criteria are already broadly based, particularly with respect to age, and could probably not be further broadened without risking results after transplantation. A varying proportion of renal allografts from living donors are used in the Scandinavian countries. An increased use of living donors, related and unrelated, in the countries where few currently are used might help meet demand in the future. At present the need for nonrenal organs can be met, but as the programs for liver and heart transplantations are developed to reach their predicted levels, the current number of donors will most likely prove insufficient.
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The two methods commonly used to diagnose cytomegalovirus (CMV) infections, conventional tissue culture and detection of early CMV nuclear antigen by immunofluorescence from cell culture, were performed in parallel on 597 clinical specimens. CMV was detected by the early-antigen test in 108 samples, of which 102 (94%) were detected 1 to 3 days after inoculation. Of these 108 CMV-positive specimens, seven were negative on conventional culture. Two samples negative in the early-antigen test were positive on conventional culture. Thus, CMV was detected in 110 specimens. A cytopathic effect in conventional tissue culture occurred 9 to 42 days after inoculation. The diagnosis of CMV infection was possible by the conventional method 29.6 +/- 12.7 days and by early-antigen immunofluorescence 1.9 +/- 1.5 days after obtaining the specimen. The rapid early-antigen test was slightly more sensitive than culture, and fewer samples were lost due to bacterial or fungal infections during incubation. Detection of CMV by conventional culture usually requires several weeks and provides a diagnosis only retrospectively. The main advantage of the early-antigen test is that a virologically proven diagnosis of CMV infection is available at an early stage.
Intravenous cytomegalovirus (CMV) hyperimmune globulin therapy was used in 24 episodes of proven CMV disease in 22 renal allograft recipients. All patients had fever up to 39-40 degrees C for at least 3 days. Many patients had thrombocytopenia, leukopenia, and/or elevation of serum transaminase levels. Five had pneumonitis. The diagnosis of CMV infection was confirmed by isolation of virus from urine or bronchoalveolar lavage fluid using a rapid culture method based on the demonstration of CMV early nuclear protein in cell culture monolayers and/or by the demonstration of CMV specific IgM antibodies. The hyperimmune globulin was given until fever disappeared. The infusions were well tolerated and no side effects were recorded. A clinical response defined as normalization of body temperature, occurred in 23/24 cases. One patient with septic fever and a fatal outcome had a superinfection with tuberculosis. Two other fatal complications were caused by invasive pulmonary aspergillosis and by multiple penetrating duodenal ulcers. Two reversible acute rejections and one recurrence of the original renal disease were recorded. 19/22 patients are alive, 18 with normal renal function. We conclude that hyperimmune globulin therapy is well tolerated and may help to control sever CMV infections in renal transplant recipients.
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