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Biomedical subjects

J H Helderman

Publications and source records attributed to J H Helderman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Renal function in primary liver transplant recipients receiving neoral (cyclosporine) versus prograf (tacrolimus).

Immunosuppressive efficacy of Neoral and Prograf following primary hepatic transplantation was comparable. Incidence of rejection episodes, infectious complications, hypertension, and postoperative diabetes mellitus was comparable. Although clinical use of both immunosuppressants was associated with early compromise in renal function, no progressive renal dysfunction was observed.

Analysis of Variance↗
PubMed1998

Impact of Sandimmune, Neoral, and Prograf on rejection incidence and renal function in primary liver transplant recipients.

Following primary liver transplantation, immunosuppressive efficacy of Neoral and Prograf was similar and superior to that of Sandimmune. Rejection incidence was statistically increased with Sandimmune therapy. Incidence of hypertension, posttransplant diabetes mellitus, and infectious complications was not statistically different. Although early compromise in renal function was associated with Sandimmune, Neoral, and Prograf immunosuppression, no progressive renal dysfunction was identified.

Adult↗
PubMed1997

The evolution and future of immunosuppression in renal transplantation.

Since the early 1960s, a number of new immunosuppressive agents have been introduced to clinical transplantation. This review will be confined to mechanism of actions, and important gains and concerns of new microemulsion formulation of cyclosporine A (Neoral), mycophenolate mofetil (MMF), FK506, brequinar sodium, sirolimus (rapamycin), leflunomide, and 15-deoxyspergualin. We will also review some of the recent studies with monoclonal antibodies.

Animals↗
PubMed1996

Renal transplantation in the older end stage renal disease patient.

Transplant physicians in the United States continue to face an interesting problem when offering kidney transplantation as a form of renal replacement therapy to older end-stage renal disease (ESRD) patients. The limited life-expectancy of these patients and an ever-present shortage of cadaveric organs makes kidney transplantation in this population a potentially controversial issue. Early results suggested poor outcomes for cadaveric renal transplantation in middle-aged or elderly ESRD patients. Improved patient selection, changes in immunosuppression regimens, and living-related transplantation have increased the success of transplantation in these patients. Efforts to define older patients at risk for cardiovascular disease and to account for their altered immune function may further improve outcomes. However, if older ESRD patients are to be rightfully included in the patient population eligible for transplantation, then the organ shortage will inevitably worsen. A potentially intriguing solution to this problem is to expand the donor pool by including older donors. Despite data suggesting that recipients of older grafts may have shorter graft survival; older donors could readily serve as a source of kidneys for older recipients who do not require 20+ year graft survival based upon their projected lifespan. Ultimately, age alone should not serve as a contraindication to renal transplantation. In patients over the age of 60, 1-year patient and graft survival rates approach 85% and 75%, respectively. However, careful assessment of "biologic" age and comorbid illnesses should be considered when offering renal transplantation to older patients.

Aged↗
PubMed1996

Acyclovir prophylaxis for cytomegalovirus disease in high-risk renal transplant recipients: is it effective?

Cytomegalovirus (CMV) is a significant cause of post-transplantation morbidity and mortality in renal transplant recipients. The risk of CMV infection is between 60 to 88% in CMV seronegative patients who receive kidneys from CMV seropositive donors (D+, R-). In order to evaluate the efficacy of oral acyclovir in prevention of CMV infection after transplantation, we retrospectively reviewed the records of 25 patients (D+, R-) who were transplanted between January 1993 and December 1995. Eighteen of 25 patients received prophylaxis with variable doses of acyclovir (600 to 4000 mg/day, adjusted for their renal function) for 4 to 7 months. CMV disease was defined as fever (> or = 38 degrees C) for at least three days which could not be attributed to other causes with positive cultures or seroconversion for CMV, and presence of either leukopenia, pneumonitis, gastroenteritis or elevated liver enzymes. Twelve of the 18 patients (66.6%) who received acyclovir prophylaxis developed CMV disease. Seven patients were hospitalized and treated with i.v. ganciclovir. One patient died from CMV pneumonia associated with invasive fungal infection five months after transplantation. Of the 7 patients who did not receive prophylactic acyclovir, 5 (71.4%) developed CMV disease (2 patients were hospitalized and treated with ganciclovir). Our results failed to confirm the efficacy of oral acyclovir as a prophylaxis against CMV disease in a small group of high-risk patients. We conclude that other strategies should be tested.

Acyclovir↗
PubMed1994

Disseminated histoplasmosis presenting as urinary tract obstruction in a renal transplant recipient.

Disseminated histoplasmosis occasionally involves the kidney, but the infection usually does not cause either urinary symptoms or a decrease in renal function. We present a case of disseminated histoplasmosis in a renal transplant recipient who presented with urinary obstruction in the allograft from a sloughed renal papilla infected with the fungus. At the same time the patient had chronic meningitis from Histoplasma capsulatum. The literature on renal involvement with histoplasmosis is reviewed.

Constriction, Pathologic↗
PubMed1994

Renal replacement therapies in the elderly: Part II. Renal transplantation.

The United States end-stage renal disease (ESRD) population is growing progressively older. As a percentage of the overall ESRD population, the number of patients 65 years of age and older approached 40% by 1989. However, the percentage of ESRD patients with a functioning transplant was only 2.7% in this age group. Success of transplantation in geriatric ESRD patients over the last decade is due to improved patient selection as well as the use of cyclosporine A and lower doses of corticosteroids, with the achievement of 1-year patient and graft survival rates of 85% and 75%, respectively. For patients older than 60 or 65 years, the 5-year "functional" graft survival is 55% to 60%. Although overall results are excellent, the management of transplantation in the elderly requires an understanding of pharmacology, immunology, and physiology peculiar to this age group. Since the elderly have a degree of immune incompetence, they require less aggressive immunotherapy. Elderly patients have decreased hepatic enzyme activity, especially the P450 system, and therefore require a lower cyclosporine dose. Although elderly patients experience less rejection episodes than younger patients, graft loss in the elderly transplant recipient is due mainly to patient death. Most common causes of death in the elderly transplant recipient are cardiovascular disease and infection related to peaks of immunosuppression. Shortage of cadaver kidneys and limited life expectancy of the geriatric ESRD patient make allocation of cadaver kidneys to patients over 70 years (and even 65 years) a controversial issue and an ethical dilemma. Use of elderly cadaver donors (over 55 to 60 years) is associated with inferior success rates and is not an optimal solution to shortage of cadaver kidneys.

Aged↗