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Biomedical subjects

K M Butt

Publications and source records attributed to K M Butt.

At least 73 records · Page 4Linked to original sources
PubMed1981

Renal transplantation in children less than 2 years of age.

We report our experience with renal transplantation in ten infants receiving grafts at ages 1 to 21 months. All children were followed for at least six months posttransplantation, except two who died in the immediate postoperative period. Kidneys were obtained from cadaveric donors: four from anencephalic newborn infants and eight others from donors aged 9 months to 21 years at death. Immunosuppressive therapy consisted of prednisone, azathioprine, and antithymocyte globulin, with added doses of methylprednisolone for rejection. Patient survival at six months was 8/10, at two years 3/7 (three patients who were alive but were followed for less than two years are excluded), and at present 5/10. Graft survival at six months was 5/10, at two years 2/12, and at present 1/12. Cadaveric renal transplantation in small children is technically feasible, but the enormous time and effort involved in such an undertaking must be re-evaluated.

Age Factors↗
PubMed1981

Evaluation of anterior extravesical ureteroneocystostomy in kidney transplantation.

We evaluated the anterior extravesical ureteroneocystostomy technique in 184 consecutive renal transplants done in 2 consecutive calendar years. Complications included 5 cases of ureteral and 1 of pelvic necrosis, and 2 of ureteral obstruction, with a ureteral complication rate of less than 4 per cent. All cases of pelvic or ureteral necrosis except 1 were seen in cadaver donor kidneys that were imported from other centers. No bladder complications were seen. Pelvioureteral obstruction, presumably of congenital origin in the cadaver donor, was discovered in the kidney after transplantation in 2 cases and was corrected successfully by pyeloureterostomy to the native ureter. The extraordinary simplicity of this technique, coupled with improvement in the complication rate, makes it our procedure of choice.

Adult↗
PubMed1981

Influence of cadaver donor age on the success of kidney transplants.

To investigate the impact of donor age on the outcome of renal transplants, a retrospective analysis of 440 consecutive cadaver donor kidney transplants were performed by dividing the transplants into six groups, according to the decade of donor age. These groups were comparable with regard to recipient age, sex, race, and HLA matching grade, while the pediatric group received kidneys preferentially from the first and second decade donors. Although cadaver donor age, between 11 and 50 years, did not appear to influence the result of kidney transplants, the kidneys retrieved from the first and sixth or higher decades of donors fared significantly worse. Improved criteria for the evaluation, selection, and management of cadaver donors of extreme ages is needed to achieve a satisfactory result.

Adolescent↗
PubMed1981

Diabetic glomerulopathy may be preventable.

Variation in blood glucose levels throughout the day was assessed in six diabetic maintenance hemodialysis patients and six diabetic renal transplant recipients. None of the twelve studied patients had good control. Glucose levels greater than 300 mg/dl were noted in four of six dialysis patients and five of six transplant recipients. A regimen of self blood glucose measurement and multiple insulin doses was instituted for four transplant and three dialysis patients. Each patient achieved the desired glucose range of 60 to 120 mg/dl most of the time, with a resultant fall in mean hemoglobin A1c concentration from 10.3% to 7.9%. It is suggested that a long term trial of self glucose monitoring might prove beneficial to treated uremic diabetics.

Adult↗
PubMed1981

Effects of dimethylnitrosamine on organ-cultured adult human pancreas.

Portions of adult human pancreas from 20 donors were organ-cultured in a chemically defined medium in the absence or presence of DMNA for up to 12 weeks. In the absence of DMNA, necrosis of some acini occurred during the first week, while some clusters of well-preserved acini were maintained for up to 3 weeks. Proliferation of the epithelial linings of main and smaller ducts and ductules was noted during the first 2 weeks of culture. Ductal epitheliums thereafter showed some degeneration but remained viable during the 12 weeks of culture. In contrast to controls, the DMNA-treated explants showed better preservation of both acinar and ductal cells. DMNA induced both ductal hyperplasia and atypia of the epithelial linings of main ducts, smaller ducts, and ductules within 6 weeks, and carcinoma by the tenth week of culture. At the end of the first week cells devoid of zymogen within the acinar complex proliferated and progressively replaced necrotic cells. During the ninth and tenth weeks, foci of atypical cells developed among these cells. Cells derived from 10-week-old DMNA-treated explants produced multiple nodules of carcinoma when injected subcutaneously into nude mice.

Animals↗
PubMed1980

Pediatric and adult renal transplants: a comparative study.

In order to compare the results of renal transplantation in pediatric and adult recipients, a retrospective analysis of first transplants done at a single institution over a 6-yr period was carried out. The study included 21 pediatric and 196 adult recipients of cadaveric grafts, and 18 pediatric and 156 adult recipients of living related grafts. Pediatric and adult recipient groups were shown to be similar to each other with respect to donor-recipient HLA antigen matching and to causes of graft failure and patient mortality. Actuarial graft and patient survival data for pediatric recipients was found to be better than for the corresponding adult recipient groups, although the differences were not statistically significant. When clinical results, technical problems, and psychosocial adaptation are considered critically, transplantation is clearly preferable to both hemodialysis and to no treatment for pediatric patients with end stage renal disease (ESRD). There is a considerable discrepancy between the estimated incidence of ESRD in children and the number of children being tranplanted for this disease. Many patients are, therefore, receiving less than optimum treatment. Efforts to correct this discrepancy are in order.

Actuarial Analysis↗
PubMed1979

Listeria monocytogenes: brain abscess or meningoencephalitis?

A brain abscess caused by Listeria monocytogenes developed in an immunosuppressed renal transplant patient. Meningitis and meningoencephalitis from this organism were encountered in three other renal transplant recipients at this medical center during the past 4 years. Focal neurologic deficits occurred in patients with either Listeria abscess or meningoencephalitis. Computerized tomography was a rapid aid to the diagnosis of abscess. Immunosuppression has increased the incidence of central nervous system Listeria infections, but ampicillin still provides effective treatment, even when immunosuppressive therapy is continued. Limited experience with Listeria brain abscess suggests that surgical intervention improves the prognosis.

Adult↗
PubMed1979

Results of renal transplantation using pediatric cadaver donors.

In order to determine the results of transplantation using pediatric cadaver donors, a retrospective analysis of a series of 502 renal transplant recipients was carried out. Methods of procurement, preservation, recipient selection, and immunosuppressive regimen were similar for all patients. Sixty-five recipients were approximately equally divided into three groups whose donors were younger than 5 years of age, 6 to 10 years old, and 11 to 15 years. These three groups then were compared with each other and to a randomly selected representative group of recipients whose donors were adults (16 years or older) for the following parameters: actuarial graft and patient survival, causes of graft failure and patient death, level of serum creatinine in currently functioning grafts, and recipient age. There were no statistically significant differences between groups for any parameter except that the mean age of recipients was approximately 16 years for the donors up to 5 years of age and was between 31 and 36 years for the other donor age groups (P = 0.01). These results support the contention that brain-dead pediatric patients of any age should be considered to be potential cadaveric kidney donors. Exclusion of these patients is very wasteful and also is unnecessary since results of transplantation equal to those obtained with adult donors can be expected. Technical graft failures should not be more frequent than with adult kidneys, and there is no need to modify the basic surgical technique for small kidneys in order to achieve this.

Adolescent↗