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K Gillingham

Publications and source records attributed to K Gillingham.

46 records · Page 3Linked to original sources
PubMed1990

The use of cadaver kidneys for transplantation in young children.

The role of cadaver kidney transplantation in the management of end-stage renal disease in young children is controversial. To assess the current risk-benefit ratio of cadaver first and second kidney transplants in recipients under 6 years of age, we compared the outcome of 19 transplants performed between 1984 and 1989 using a quadruple-drug regimen (Minnesota antilymphocyte globulin, azathioprine, prednisone, cyclosporine) with the outcome of 25 transplants performed prior to 1984 without the use of cyclosporine at a single institution. Twenty-five transplants were in children under the age of 3 years. In the last decade patient survival has significantly improved. One-year patient survival improved from 53% before 1979 to 90% since 1979 (P less than 0.05). The use of the quadruple-drug regimen since 1984 was associated with a significant improvement in one-year cadaver graft function from 40% before 1979 to 78% in recipients under 6 years of age, and from 22% to 82% in recipients under 3 years of age (P less than 0.05). With the quadruple-drug regimen, one-year and four-year graft function rates for children under 6 years of age were 83% for first cadaver transplants and 72% for second cadaver transplants, which were essentially the same results as in older children and adults. Children who received kidneys from donors over 4 years of age achieved the best result, with 87% one-year graft function compared with 50% for kidneys from donors under 4 years old. In 15 children with successful transplants, 8 (53%) showed accelerated growth, 5 (33%) had normal-velocity growth, and only 2 children (14%) with suboptimal renal function had poor growth following transplantation. Therefore, we believe that with a quadruple-drug immunosuppressive protocol, cadaver renal transplantation using kidneys from adults or pediatric donors over 4 years old is an acceptable form of treatment in young children with end-stage renal disease for whom there are no suitable living-related donors.

Adolescent↗
PubMed1990

Pancreas transplantation: report on United States results from United Network for Organ Sharing Registry with comparison to non-United States results from the International Registry.

From December 17, 1966 to December 31, 1990, 3,069 pancreas transplants worldwide (1,806 United States and 1,263 non-United States) were reported to the International Pancreas Transplant Registry, including 606 in 1990. The 2,871 pancreas transplants in the Registry data base as of October 31, 1990 were analyzed. Results worldwide improved in each of 5 successive eras. The recipient and pancreas graft functional survival rates at 1 year for all 1988 to 1990 cases (n = 1,415) were 91% and 68%, respectively. The effect of multiple variables on outcome was determined by analyzing the 2,037 cases in the International Registry data base since 1985. Worldwide, BD (n = 1,566) was used more frequently than DI (n = 327) or ED (n = 174) and was associated with a significantly higher (p less than 0.001) graft functional survival rate, at 1 year 65% versus 56% and 53%, respectively. Worldwide, SPK transplants (n = 1,644) were performed much more frequently than either PAK (n = 223), or PTA (n = 212). The pancreas graft functional survival rate was significantly higher (p less than 0.001) in the SPK than in the other 2 categories, at 1 year being 68% versus 45% and 37%, respectively. The kidney graft survival rate for all SPK cases at 1 year was 80%. Worldwide, a significant effect of HLA-DR matching was seen only in analysis of PTA, graft survival at 1 year being 54% in PTA recipients matched for 2 DR antigens (n = 13), 44% for 1 DR antigen (n = 63) and 29% for 0 DR antigens (n = 97) (p = 0,015 for 2 vs 0 DR). Worldwide, more than half of the pancreas grafts were preserved in UW solution (n = 1,111), and an increasing preservation length was not associated with a significant decrease in functional survival rates, at 1 year being 67%, 73%, 71%, and 60% for those stored less than 12 (n = 563), 12-24 (n = 416), 24-30 (n = 30), and greater than 30 (n = 5) hours. A separate analysis was performed on pancreas transplants in the United States reported to the UNOS Registry from its inception on October 1, 1987 to October 21, 1990 (n = 1,021). Almost all pancreas transplants in the United States during this period were by the BD technique (92%). The overall patient and pancreas graft survival rates were 92% and 72% at 1 year.(ABSTRACT TRUNCATED AT 400 WORDS)

Follow-Up Studies↗
PubMed1989

Pancreas transplantation: report from the International Registry and a preliminary analysis of United States results from the New United Network for Organ Sharing (UNOS) Registry.

This report contains information on analysis of 2,292 pancreas transplants worldwide reported to the International Pancreas Transplant Registry from 1966 through 1989, with 1-year recipient survival rates improving from 39% to 71% to 80% to 87% and 1-year graft survival rates from 5% to 26% to 40% to 56% for 1966 to 1977 (n = 64), 1977 to 1983 (n = 336), 1984 to 1985 (n = 364), and 1986 to 1989 (n = 1,220) cases, respectively. The last 2 eras were combined for analyses of multiple variables. In the analyses of all world cases for the 1984 to 1989 period (n = 1,604), the most important finding was the influence of HLA-DR matching or mismatching on pancreas graft survival rates; 1-year function rates for grafts in recipients matched for 2, 1, or 0 DR antigens with the donor were 73% (n = 52), 53%, (n = 468), and 48% (n = 67) (p less than 0.005 for all comparisons). Likewise, in an analysis of 1984 to 1989 cases according to DR mismatching, the 1-year graft survival rates with 0, 1, or 2 DR mismatches were 63% (n = 128), 50% (n = 583), and 49% (496) (p less than 0.02). An analysis of the 1986 to 1989 era cases worldwide confirms the trend in the period analysis for bladder drainage (BD) to be associated with significantly higher graft survival rates than intestinal drainage or duct injection, at 1-year being 59% (n = 656), 47% (n = 97), and 54% (n = 210). Likewise, for the 1986 to 1989 era, worldwide 1-year pancreas graft functional survival rates were significantly higher in recipients of simultaneous-pancreas/kidney transplants (SPK) than in recipients of pancreas-after-kidney (PAK) or a pancreas-transplant-alone (PTA); 63% (n = 865), 45% (n = 186), and 37% (n = 165). In a new analysis of the United States cases reported to the UNOS Registry from October 1, 1987 through June 30, 1989, 1-year patient and graft survival rates were 91% and 69%. Almost all United States cases reported to the UNOS Registry during 1987 to 1989 were with BD (n = 324).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Results of pediatric kidney transplantation at the University of Minnesota.

In all, 473 renal transplants were performed at the University of Minnesota in 386 children 1-17 years old between August 14, 1963 and December 31, 1988. Standard immunosuppressive protocols, pretransplant blood transfusions, and discontinuation of routine splenectomy have led to improving graft and patient survival rates. Children receiving living-related donor kidneys had better graft and patient survival rates, compared to cadaver kidneys. Graft and patient survival rates were better in children who received primary grafts, compared to retransplants. Children who received DST plus conventional immunosuppression had poorer graft survival, compared to quadruple immunosuppression during the same era. Recently, 1-year graft survival rates with quadruple immunosuppression are equal for children receiving primary, living-related donor or cadaver kidneys. Graft and patient survival rates in children 1-4 years old are identical to those in children 5-17 years old. Age no longer appears to be a risk factor for children undergoing kidney transplantation. Good patient and graft survival rates can be achieved at centers specializing in kidney transplantation for small children. Currently, transplantation is the treatment of choice for all children who are candidates for renal replacement therapy.

Adolescent↗