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Biomedical subjects

K Gillingham

Publications and source records attributed to K Gillingham.

At least 37 records · Page 2Linked to original sources
PubMed1993

Risk factors for chronic rejection in renal allograft recipients.

Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P = .08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P < .0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (< 18 years, 18 to 50 years, > 50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (< 5 mg/kg vs. > or = 5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P < .001), CsA dosage < 5 mg/kg/day at 1 year (P = .007), infection (P = .023), female gender (P = .042), and retransplant (P = .103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage < 5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections).

Adolescent↗
PubMed1992

Pediatric renal transplants--results with sequential immunosuppression.

Cyclosporine has improved the results of renal transplantation. In 1984, we began using it as part of a sequential immunosuppression protocol (MALG, AZA, P, and delayed administration of CsA) in our pediatric renal transplant recipients. We studied the outcome of the 131 pediatric renal transplants (less than or equal to 18 years of age at transplant) performed at our institution between June 1984 and March 1991. We compared these results with the 144 similar transplants performed since January 1980 that did not involve CsA immunosuppression. In the sequential immunosuppression group, there were 97 primary (74%) (26 [27%] cadaver, 71 [73%] living donor [LD]) and 34 (26%) retransplant (23 [68%] CAD, 11 [32%]) recipients. Age at transplant (mean +/- SD) was 7.4 +/- 5.5. Overall, 1-year actuarial graft survival was 93%; 1-year patient survival was 100%. The mean number of hospital readmissions was 3.0 +/- 3.5; 26 (20%) were readmission-free. The mean number of rejection episodes was .87 +/- 1.3 per patient; 73 (56%) were rejection-free. Importantly, LD (vs. CAD) recipients had fewer rejection episodes (P = 0.06). In the first post-transplant year, the serum creatinine level was significantly lower in primary (vs. retransplant) recipients and in LD (vs. CAD) recipients (P less than 0.05). In the 144 patients not receiving CsA, there were 129 (90%) primary (27 CAD, 102 LD) and 15 (10%) retransplant (7 CAD, 8 LD) recipients. Age at transplant was 6.9 +/- 5.3 years. The 1-year actuarial graft survival rate was 82%; the 1-year patient survival rate was 94%. The mean number of hospital readmissions was 3.3 +/- 2.3; 5 (8%) were readmission-free. The mean number of rejection episodes was 1.2 +/- 1.5; 27 (45%) were rejection-free. There was no difference in the serum creatinine level based on donor source or transplant number. Sequential immunosuppression has significantly improved patient (P = 0.003) and graft survival (P = 0.004) rates. Comparing sequential vs. non-CsA immunosuppression, there was no difference in the number of readmissions (P = 0.47), number of rejection episodes (P = 0.17), or serum creatinine level. The number of rejection-free patients was significantly lower in LD (vs. CAD) recipients (P less than 0.05). There was no evidence of progressive deterioration in renal function in the sequential (vs. non-CsA) recipients.

Adolescent↗
PubMed1992

Kidney transplantation in patients with type I diabetes: 26-year experience at the University of Minnesota.

With current immunosuppressive protocols, 1- and 6-year graft survival is similar in diabetic and nondiabetic kidney transplant recipients. Living-donor transplant recipients have significantly better outcome. Death with function and chronic rejection remain the 2 predominant causes of graft loss for diabetic recipients. Compared with national statistics on diabetic patient survival on dialysis, our data suggest that transplantation is the treatment of choice for diabetic patients with end-stage renal disease.

Adolescent↗
PubMed1991

Risk factors for second renal allografts immunosuppressed with cyclosporine.

Second renal allograft survival rates are lower than those of primary allografts. For recipients immunosuppressed with azathioprine, prednisone, and Minnesota ALG (conventional immunosuppression), risk factors associated with decreased second graft survival have been identified: age greater than 40, cadaver donor, less than 6 months between primary graft loss and retransplantation, duration of primary graft function (6 months or 1 year, depending on the study), high peak panel-reactive antibody, number of human leukocyte antigen mismatches, and delayed graft function. In this study, we used a multivariate analysis to identify risk factors associated with decreased second graft survival in patients who did or did not receive cyclosporine. Results were compared with primary graft survival rates. Risk factors for patients receiving conventional immunosuppression were: (a) primary graft loss caused by rejection greater than or equal to 6 months (P = 0.01 vs. either rejection less than 6 months or nonimmunologic loss); (b) cadaver donor (P = 0.005 vs. living related); and (c) interval between primary graft loss and retransplantation of greater than or equal to 6 months (P = 0.05 vs. less than 6 months). For CsA, risk factors that most decreased second graft survival were: (a) primary graft loss caused by rejection less than 6 months (P = 0.11 vs. nonimmunologic loss); (b) conventional immunosuppression for the primary graft (P = 0.08 vs. CsA immunosuppression); and (c) a peak PRA of greater than or equal to 21 (P = 0.14 vs. peak PRA of 1-20). For second graft recipients immunosuppressed with CsA, primary graft loss to either rejection greater than 6 months posttransplant or nonimmunologic causes was not a risk factor for second graft survival. These data extend the recent reports of other investigators by identifying risk factors for retransplant recipients treated with CsA and by demonstrating that subgroups of patients in the retransplant population can be retransplanted without additional risk (i.e., their second graft survival rates are similar to primary graft survival rates). This may become more important if, in the future, organ distribution is based on graft survival data. If so, our data would support retransplantation in patients who are immunosuppressed with CsA, especially those who lost their primary graft to either rejection greater than or equal to 6 months posttransplant or nonimmunologic causes; who receive living related grafts; and who have a peak PRA of 1-20.

Adult↗
PubMed1991

Is dantrolene safe to administer in sepsis? The effect of dantrolene after endotoxin administration in dogs and rats.

Hyperthermia from septic shock may be indistinguishable from malignant hyperthermia. Dantrolene may be given in septicemia if the diagnosis is unclear. To determine if dantrolene is safe to use in sepsis, two studies were performed. In study 1, 18 anesthetized dogs in which profound septic shock was induced with 5 mg/kg of intravenous Escherichia coli endotoxin were randomized to receive (30 min later) intravenous injections of 10 mg/kg of dantrolene solution, the diluent of dantrolene, or maintenance intravenous fluids alone. The use of dantrolene solution and the diluent of dantrolene resulted in similar but transient statistically significant increases in the cardiac filling pressures and cardiac outputs and decreases in the vascular resistances compared with the control dogs. In a second study, 185 rats were randomized into five equal groups. Groups 1, 2, and 3 received 15 mg/kg of intraperitoneal Escherichia coli endotoxin followed 30 min later by 10 mg/kg of dantrolene solution, the diluent of dantrolene, or normal saline. Groups 4 and 5 received normal saline followed by dantrolene or normal saline. The survival of groups 1, 2, and 3 was less at 24 h (P less than 0.0001) than that of either control group, but was not significantly different from one another. The results suggest dantrolene can be administered safely under clinical conditions where the cause of hyperthermia and shock cannot clearly be ascribed to malignant hyperthermia or septicemia.

Analysis of Variance↗
PubMed1991

Results of pancreas transplantation in the United States for 1987-90 from the United Network for Organ Sharing (UNOS) Registry with comparison to 1984-87 results.

An outcome analysis was performed on pancreas transplants in the United States reported to the United Network for Organ Sharing (UNOS) Registry from its inception on 1 October 1987 to 21 October 1990 (n=1021). These cases comprise nearly one-third of the 3082 pancreas transplants reported to the International Pancreas Transplant Registry (1819 U.S., 1263 non-U.S.) from 1 December 1966 to 31 December 1990, including 619 in 1990 (528 U.S., 91 non-U.S.). Nearly all pancreas transplants in the U.S. during the 1987-90 period were by the bladder-drainage (BD) technique (92%). The overall patient and pancreas graft actuarial survival rates were 92% and 72% at 1 year. Patient survival rates were similar in all recipient categories, but pancreas graft survival rates were significantly higher (p less than 0.001) in recipients of a simultaneous pancreas and kidney (SPK) transplant (n=883) than in recipients of a pancreas after a kidney (PAK, n=112) or a pancreas transplant alone (PTA, n=71), being 77%, 52%, and 54%, respectively, at 1 yr. Kidney graft survival at 1 yr in U.S. SPK recipients was 86%. Most grafts (81%) were preserved in University of Wisconsin (UW) solution, and more than half were stored greater than 12 hours, with no difference in outcome with increasing duration of storage. At 1 yr, functional survival rates were 72% for U.S. pancreas grafts stored for either less than 12 (n=439), 12-24 (n=422), or 24-30 h (n=42). For grafts stored greater than 30 h (n=8), the 1-yr functional survival rate was 50% (p=ns versus the other storage times). On univariate analysis, no effect of HLA antigen mismatching on outcome for 1987-90 U.S. cases could be discerned. The results in the UNOS Registry were compared to the results for U.S. cases in the International Pancreas Transplant Registry performed between 1 January 1984 and 30 September 1987. In all recipient categories the pancreas graft functional survival rates were significantly higher in the 1987-90 (UNOS) than in the 1984-87 (pre-UNOS) era. A Cox multivariate analysis of 1984-90 cases showed the relative risk for pancreas graft loss to be significantly less (p less than 0.05) with bladder-drainage, with simultaneous transplantation of the kidney, with use of UW solution for preservation, and with 0-1 HLA-A, B, DR or 0 HLA-DR mismatches.(ABSTRACT TRUNCATED AT 400 WORDS)

Graft Survival↗
PubMed1991

A single institution's experience with solitary pancreas transplantation: a multivariate analysis of factors leading to improved outcome.

The results of cadaveric donor pancreas transplantation at a single institution using the bladder drainage technique have been analyzed according to several factors that may impinge on outcome. Both multivariate and univariate statistical methods were used, with emphasis on solitary (pancreas after kidney and pancreas transplant alone) as opposed to simultaneous pancreas/kidney transplants. Of the 444 pancreas transplants performed at our institution from December 1966 through December 1991, we analyzed 249 bladder-drained cadaver donor pancreas transplants from November 1984 through August 1991. The factors that had a significant impact on outcome in the Cox multivariate analysis included retransplantation, age, preservation time, and degree of HLA mismatching. The results of solitary pancreas transplants improved with time as the factors that have an impact on graft survival rates were deliberately manipulated. During the 1988 to 1991 era, pancreas graft functional survival (insulin-independent) rates were not significantly different among the 3 recipient categories. Solitary pancreas transplant recipients less than 45 years old receiving primary grafts had a 1-year function rate of 61% in the pancreas transplant alone group (n = 32) and 74% in the pancreas after kidney group (n = 24). By placing emphasis on minimizing HLA mismatches, by giving adequate immunosuppression, and by detecting and treating rejection episodes early based on a decline in urine amylase, the results with solitary pancreas transplantation can be as good as those with simultaneous pancreas kidney transplantation. There are limitations to the interpretations that can be given to retrospective studies using inhomogeneous factors, as is the case in the analyses presented here. We cannot identify risk factors with certainty because the protocols changed over time, eg, immunosuppressive regimens, policies on HLA matching, and choice of duct-management techniques. Thus, in the analysis of all cases, not only was there a higher proportion by the bladder-drainage techniques in the later period, but the proportion of cases with good HLA matches was also higher: yet the earlier cases (more poorly matched, performed by the other techniques, and with worse results), were in the model. Retransplantation is also a problem for the analysis. The number performed was proportionately greater in the later period, and the possibility of retransplantation differed according to the patient's age. Over such a long time, we cannot evaluate our gain in experience statistically.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗