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Biomedical subjects

J M Barry

Publications and source records attributed to J M Barry.

At least 127 records · Page 7Linked to original sources
PubMed1983

Human kidney preservation using machine perfusion followed by intracellular electrolyte flushing.

Transplant centers that do not have pulsatile machine perfusion capabilities are reluctant to accept kidneys from programs that do. Four human kidneys were retrieved by other centers, initially placed on pulsatile machine perfusion pumps for 13 to 28 hours, removed from the pumps, flushed with intracellular electrolyte solutions and cold-stored for 13 to 36 hours before transplantation at our institution. All recipients required dialysis during the first week after transplantation. The 1-month serum creatinine nadir was 2.2 plus or minus 1.1 mg. per dl., and all kidney grafts were functioning 3 months after transplantation. Pulsatile machine perfusion followed by ice-cold intracellular electrolyte flushing and simple cold storage can provide satisfactory renal function when the warm ischemia time is short.

Cold Temperature↗
PubMed1983

Comparison of imported with locally retrieved kidneys preserved by intracellular electrolyte flushing followed by cold storage.

Ice-cold intracellular electrolyte flushing followed by cold storage and economy air shipment is the cheapest method to share kidneys for transplantation. This study from 1 center compares 62 primary cadaver kidney grafts imported from other centers to 128 that were retrieved locally. Cold ischemia time was 36.4 plus or minus 8.6 hours (mean plus or minus standard deviation) in the imported group and 24.2 plus or minus 8.8 hours in the locally retrieved group. The significant increase in first week dialysis (71 versus 42 per cent) and 1-month serum creatinine nadirs (2.63 plus or minus 2.73 versus 1.78 plus or minus 1.04 mg./dl.) was explained by longer cold ischemia times in the imported kidney grafts. There were no significant differences between the 2 groups with respect to actuarial kidney graft survivals and serum creatinine levels at 1, 2 and 3 years. Intracellular electrolyte flushing followed by simple cold storage and air transportation provides kidney graft survivals and long-term kidney graft function at minimal expense when the kidneys are retrieved from beating-heart cadavers and have undergone minimal warm ischemia.

Cold Temperature↗
PubMed1983

Successful human kidney preservation by intracellular electrolyte flush followed by cold storage for more than 48 hours.

Transplantation of cadaver kidneys after flushing with an ice-cold intracellular electrolyte solution is inhibited by arbitrary time limits on cold ischemia. During the 25-month interval ending March 22, 1982 we transplanted 7 kidneys preserved by this method and cold-stored for 48.2 to 61.4 hours. Of the recipients 86 per cent required dialysis within 1 week after transplantation, the mean serum creatinine nadir within 1 month was 2.1 mg./dl. and the graft survival at 1 month was 71 per cent. The 1-year actuarial cadaver graft survival was 69.2 plus or minus 18.1 per cent. Kidneys preserved by this simple method can be transplanted successfully after 48 hours of simple cold storage.

Cold Temperature↗
PubMed1983

Percutaneous vaso-occlusion for nonmalignant renal lesions.

Transarterial renal embolization has been used in the management of renal cancer. We report on 9 patients who underwent selective and superselective renal arterial embolization for nonmalignant renal lesions. Embolization was done in 5 patients for hemorrhage owing to renal angiomas, renal artery, pseudoaneurysm, percutaneous renal biopsy and adult polycystic kidney disease, and in 2 patients with end stage renal disease because of massive proteinuria. Another chronic renal failure patient with severe hypertension was treated successfully with bilateral renal embolization. A postoperative renal arteriovenous fistula was treated successfully by catheter vaso-occlusion. Renal embolization may be a suitable alternative to surgery in poor operative risk patients and for technically difficult benign lesions. Renal infection is a contraindication to embolization.

Adult↗
PubMed1983

Unstented extravesical ureteroneocystostomy in kidney transplantation.

An alternate procedure for extravesical ureteroneocystostomy is described. The procedure is useful because of the lateral placement of the ureter, limited cystotomy and limited exposure of the bladder. There were no ureteral complications in 11 patients undergoing kidney transplantation with this technique of urinary tract reconstruction.

Humans↗
PubMed1983

Postrenal transplant erythrocytosis: a review of 53 patients.

Review of a large renal transplant experience revealed a 17.3% incidence of posttransplant erythrocytosis. The influence of kidney source, pretransplant hematocrit, duration of pretransplant dialysis, renal transplant function, acute rejection, transplant renal artery stenosis, urinary tract obstruction, smoking, diabetes, retention of native kidneys, splenectomy, parathyroidectomy, immunosuppression, hypertension, and liver enzyme abnormalities on the development of erythrocytosis in 53 recipients was determined. Comparison was made with 49 control recipients matched for kidney function, time after grafting, age, and sex. Erythrocytosis occurred 3 to 90 months after transplantation and persisted for 1 to over 84 months. Risk factors for the development of erythrocytosis were smoking, diabetes, and a rejection free course. In contradistinction to previous smaller series, erythrocytosis occurred in patients with good renal function (serum creatinine 1.62 +/- 0.43 mg/dl) without prominence of graft rejection, transplant artery stenosis or obstruction. Despite therapeutic phlebotomy, 11 thromboembolic events occurred in 10 of the 53 patients with erythrocytosis, but in none of the controls (P less than 0.001). The high incidence of erythrocytosis following renal transplantation and the risk of associated thromboembolic events should encourage awareness and controlled evaluation of therapeutic modalities.

Adolescent↗
PubMed1983

Beneficial effect of pre-transplant splenectomy for leukopenia in primary cadaver kidney transplants.

Pre-transplant splenectomy is controversial. We compared 21 nondiabetic, transfused recipients of first cadaver kidney grafts who underwent pre-transplant splenectomy for steroid-resistant leukopenia to 114 without steroid-resistant leukopenia. Kidney graft survivals at 2 years were 80.2 plus or minus 8.9 and 48.5 plus or minus 5.3 per cent, respectively (p less than 0.05). The 2-year actuarial patient survivals were not significantly different (89.6 plus or minus 7.0 versus 87.8 plus or minus 3.9 per cent). Azathioprine doses and serum creatinine levels at 1 year were not significantly different. Pre-transplant splenectomy for steroid-resistant leukopenia resulted in a significant decrease in kidney graft losses owing to rejection without an increased risk of death of sepsis or thromboembolism.

Azathioprine↗
PubMed1982

Comparison of standard immunosuppression with adjuvant antilymphoblast globulin in primary cadaver kidney transplant survival.

Adjuvant, prophylactic, antilymphoblast globulin and standard immunosuppression have produced comparable long-term cadaver kidney graft survivals at separate institutions. A comparison was made of 35 primary cadaver kidney grafts into recipients treated with prophylactic, adjuvant antilymphoblast globulin to 55 recipients of primary cadaver kidney grafts treated with standard immunosuppression. Antilymphoblast globulin delayed early rejection episodes (P under 0.05), making early post-transplant management simpler. There were no significant differences between the two groups with respect to graft losses due to rejection at any interval beyond one month.

Antilymphocyte Serum↗
PubMed1982

Retreat from transpubic urethroplasty for obliterated membranous urethral strictures.

A direct vision urethrotome was used to incise the perineal membrane and join the proximal bulbous urethra to the dorsal prostate in 4 men with totally obliterated posterior urethras following pelvic fractures. All 4 patients have maintained patent urethras for 2 to 9 months. Progressive dilation has not been required in 3 men. A repeat internal urethrotomy was necessary in 1 patient who currently requires urethral sounding every 6 weeks. A comparison with 8 previous transpubic urethroplasties for the same surgical problem revealed a significant decrease in blood loss and hospital stay with direct vision urethrotomy. Transurethral incision of the obliterated posterior urethra following a crushing injury to the pelvis may be a reasonable initial procedure for restoring urethral continuity prior to more extensive urethroplasty.

Adult↗
PubMed1982

Effect of donor surgeon on first cadaver kidney transplant function.

Community urologists and general surgeons were recruited into a cadaver kidney program in 1976. This study from 1 center compares 41 primary cadaver kidney grafts retrieved by community hospital retrieval teams to 60 primary cadaver kidney grafts retrieved by a center-based transplant team. Of the kidneys 100 were preserved with Collins' C2 flushing followed by simple cold storage and 1 was preserved with pulsatile machine perfusion. Cold storage time ranged from 9 to 44.5 hours in the community hospital kidney group and from 11 to 44 hours in the university hospital group. There was no significant difference between the 2 kidney retrieval teams with respect to 1) incidence of acute tubular necrosis, 2) 1-month serum creatinine nadir of surviving grafts, 3) 1 and 2-year serum creatinine levels and 4) actuarial graft survivals up to 5 years. Community hospital retrieval teams can provide kidneys as satisfactory for transplantation as a center-based transplant team and are a valuable resource for cadaver kidney transplant programs.

Adult↗