Biomedical subjects
Publications and source records attributed to J Jervell.
31 patients with renovascular hypertension, calculous disease, short ureter or renal carcinoma (single kidney) were treated with renal autotransplantation, in 3 patients bilaterally. There were 2 deaths due to cardiac arrest and myocardial infarction. Secondary nephrectomy was performed in 2 patients, and thus 29 of 31 autotransplanted kidneys were salvaged.
The influence of HLA matching has been studied in the Norwegian material of 142 living related and 311 cadaveric transplants. Graft survival corresponded closely to the degree of HLA haplotype disparity between donors and recipients. Furthermore, graft survival was less in combinations being incompatible for the serologically defined HLA-A and -B antigens as compared to compatible combinations. A weak MLC response, indicating a possible sharing of the HLA-D determinants between donor and recipient, was also associated with superior graft survival, even in the presence of HLA-A and -B disparity. Matching for HLA-C in addition to HLA-A and -B did not seem to improve graft survival.
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Since 1972 65 patients with diabetic nephropathy have been evaluated for renal transplantation. Twenty one were not accepted, 6 died before transplantation and 10 are still under observation. Of 28 transplanted patients 13 are alive with functioning graft, and 3 are treated with hospital dialysis. Patient survival at one year was 65% and graft survival 50%.
The influence of HLA matching has been studied in a Norwegian material of 147 living related first transplants, 281 cadaveric first transplants and 48 cadaveric second transplants. Graft survival corresponded closely to HLA antigen disparity and degree of MLC response in combinations transplanted with kidneys from living related donors. In patients transplanted with cadaveric grafts. HLA identical and compatible grafts performed significantly better than imcompatible grafts. Matching for HLA-C in addition to HLA-A and -B did not seem to improve graft survival.
The influence of blood transfusions on kidney graft survival in 167 first cadaveric transplants and 85 first living related transplants is presented. Blood transfusions had no effect upon kidney graft survival in the patients transplanted with kidneys from living related donors. A significantly better graft survival was observed in the transfused group of patients transplanted with cadaveric kidneys. This beneficial effect was most pronounced in men. When patient survival was analyzed, however, a possible beneficial effect of blood transfusions was almost nulled out when patients dying while waiting for a transplant were included. The majority of these latter patients had been transfused and many had formed HLA antibodies.
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The role of the liver in the elimination of infused glucose during recovery after exercise was studied in 5 normal and 4 juvenile diabetic males. The results were compared with those of a resting experiment. The subjects exercised on the bicycle ergometer at a work rate requiring about 70% of their max. Vo2. 0.5 g glucose per kg body weight was infused as a single injection 15 min after the cessation of exercise. Arterial-hepatic vein (a-hv) glucose and lactate differences were measured repetitively both during exercise and throughout the 79 min recovery period. During exercise the a-hv glucose differences were negative and increased more than sixfold in the diabetic subjects and more than tenfold in the non-diabetic subjects. After the glucose infusion the a-hv glucose differences were still negative in the diabetic subjects, indicating a continued net release of glucose from the liver in spite of elevated arterial glucose concentrations. In the non-diabetic subjects there was a small uptake of glucose, accounting for about 0.5% of the total glucose load given. The a-hv lactate differences were larger in the diabetic subjects, indicating a greater dependence upon gluconeogenesis as compared with the non-diabetic subjects. It is concluded that the liver is of no importance in the diabetic subjects and of only slight importance in the non-diabetic subjects for the disposal of infused glucose during the initial hour of recovery after exercise.
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