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Biomedical subjects

L Berardinelli

Publications and source records attributed to L Berardinelli.

At least 19 recordsLinked to original sources
PubMed1996

Ethical aspects of using "marginal" kidneys for transplant.

The continuing demand for transplantable organs leads to ongoing debates about organ procurement, even with arguments in favour of xenotransplantation as a valid alternative. This article examines the management of kidneys with major anatomical anomalies, almost one-quarter of those available for transplantation in our experience: the decision-making is considered from a scientific and an ethical standpoint. Surgical techniques include primary revascularization (PR) and/or bench-top reconstructions (BR). The results, examined for 1311 normal grafts (Group I) and 362 grafts presenting major anatomical anomalies (Group II), all transplanted for the first time, showed almost the same rates of failures due to surgical causes in these two groups. No operative mortality was associated with any of the vascular techniques, BR being easier and safer than PR. Graft survival at 1 year is the same for Group I and Group II (85% versus 84%, respectively). An ethical allocation system ought to take into account the experience of the transplant surgeon for maximizing outcome and minimizing cost and risk for transplantation.

Ethics, Medical↗
PubMed1995

Safe utilization and long-term follow-up of 368 marginal kidneys.

Three-hundred sixty-eight grafts of 1701 KTs performed during a 25-year period showed major anatomical anomalies: 358 kidneys presented an abnormal vascular supply, 8 organs had a double ureters, 2 were indivisible horseshoe kidneys. The outcome of these MKs is virtually identical (84%) to those obtained with transplant of normal grafts (85%). The advantages of ex vivo arterioplasty have been advocated.

Anastomosis, Surgical↗
PubMed1994

Twenty-five years of transplant experience at Policlinico University Hospital of Milan.

1. CsA treatment played a major role in the improvement of renal transplantation in the third era of our experience for every class of recipient. Many of the most recent patients involved higher risks than in previous eras. 2. The type of donor (LD or CD) did not make a significant difference in patient or graft survival rates up to 4 years. However, the survival rate of LD kidney transplants was better in later follow-ups than that of CD transplants. Pediatric and older kidneys can be used safely, although a lower survival rate is achieved by these grafts. 3. The sex and the side (right or left) of the donor kidney does not affect the outcome of transplantation. 4. In both multiorgan and single-kidney donor origin, there was no difference in graft survival. As all MOD kidneys were flushed with UW Solution and all SKD kidneys were flushed with EC Solution, we can assume that there is no difference in graft outcome, whichever of these solutions is employed. 5. The limited availability of CD grafts has been overcome by using marginal kidneys and adopting extracorporeal microvascular techniques. The results compared well with those of normal allografts. 6. The transplant outcome is penalized by expected higher mortality in older patients. And in pediatric patients there is a higher rate of graft failure due to rejection. 7. Retransplanted grafts under CsA have a better success rate than those using conventional therapy. 8. Extrarenal pathology and the actual risk ratio for CsA-treated recipients still need to be defined by future follow-ups. 9. Our results in renal transplantation, particularly from CDs, could be defined as good in comparison to those of other large transplant centers. 10. The main problem remains that the supply of CD kidneys has decreased in recent years, whereas the demand is increasing, perhaps due to the opening of other transplant centers, an inadequate policy for organ procurement, and ineffective legislation, the last being essential to promote kidney transplantation.

Actuarial Analysis↗
PubMed1992

Advantages of cyclosporine as sole immunosuppressive agent in children with transplanted kidneys.

A prospective study of intentional stopping of steroids 6 months after transplantation was done with 29 pediatric renal transplant recipients with a mean age of 10.4 +/- 3.4 years. Immunosuppression consisted of cyclosporine and methylprednisolone. We stopped giving MP to 24 children: to twenty after six months, four after 11-20 months. "Crude graft survival" was 97% during a mean follow-up of 36.7 +/- 15 months. The rejection rate was 48% during the first 6 months and 29% in the period after stopping MP. At present, 20/24 children (83%) have remained on CsA alone (18 patients) or CsA and azathioprine (2 patients) during a mean follow-up of 30 +/- 17 months. CsA nephrotoxicity occurred in 20.6% of patients, gum hypertrophy in 45%, hypertrichosis in 24%, and neurological symptoms in two patients (6.8%). Linear growth significantly improved after stopping MP: mean catch-up growth for prepuberal children 1.38 height standard deviation score (HSDS) and for pubertal children 1.6 HSDS. Bone age did not increase more rapidly than chronologic age. Weight/height index (W/HI) also improved. There was also a significant reduction in the use of antihypertensive drugs. Calculated glomerular filtration rate was decreased, though not significantly, after stopping MP. Thus, when graft survival is good, stopping corticosteroids corrects the major handicap of children with irreversible uremia--the poor linear growth--and improves the W/HI and control of arterial pressure. Longer follow-up periods are necessary to exclude significant worsening of renal function and an increased incidence of chronic rejection after stopping the steroid.

Adolescent↗
PubMed1990

Prolactin, thymulin and zinc in chronic hemodialysis: effect of renal transplant.

The interrelationships between PRL, thymulin and Zn, were studied in 25 patients with chronic renal failure (CRF) undergoing kidney transplantation and immunosuppressed with cyclosporine A (CsA). The possible role of serum PRL levels in predicting allograft rejection was also investigated. Before the kidney transplant serum PRL levels were significantly higher than in normals (mean +/- SE, 28.3 +/- 7.1 vs 7.5 +/- 0.6 micrograms/l, p less than 0.001) and their response to TRH (200 micrograms iv) was impaired (mean delta % at peak, 45.4 +/- 9.5 vs + 641 +/- 47.5, p less than 0.001). After kidney transplantation a dramatic decrease in serum PRL concentrations was observed in all patients, followed by a slight upward trend in the following two weeks, while TRH test administered on 3rd, 7th and 14th day, induced a progressive increase in serum PRL responses (delta % at peak, 201 +/- 43.3, 220 +/- 37.1 and 305 +/- 15.5, respectively). No difference in serum PRL patterns was observed between patients with (8 cases) and without (17 cases) clinical features and kidney fine needle biopsies suggestive of rejection. Basal serum Zn levels of patients with CRF (18.1 +/- 0.6 mumol/l) were similar to those observed in normals (17.7 +/- 0.2 mumol/l) and without any correlation with serum PRL levels. A decrement in serum Zn was recorded during CsA infusion and on the first day after the surgery, followed by a slight and slow upward trend. Basal serum thymulin titers were low [2.92 +/- 0.18 (1/log2)], were further reduced after CsA infusion [1.68 +/- 0.15 (1/log2)] and returned to the pretransplant levels in the two weeks after grafting.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

A randomized trial comparing triple-drug and double-drug therapy in renal transplantation.

A controlled trial was carried out in 86 cadaveric and 14 living haploidentical renal transplant recipients to compare the effects of low doses of cyclosporine (CsA), azathioprine (Aza) and steroids with those of higher doses of CsA plus steroids. Patients were followed for 12-26 months after transplantation. The actuarial 2-year patient and graft survival rate was 100% for living-donor transplants. In cadaver renal transplants the 2-year patient survival rate was 100% for patients assigned to the triple regimen and 93% for those allocated to the double regimen. The actuarial 2-year cadaver graft survival rates were 86% and 90.6%, respectively. There were significantly more patients who had severe infections (P less than 0.05), particularly interstitial pneumonia (P less than 0.005), in the double-therapy group. On the other hand, there were more patients who rejected and more patients with severe rejections; more pulses of steroids were also required for patients on the triple regimen, although these differences were not significant. The mean trough blood levels of cyclosporine at the various times were about half as high in patients on triple therapy. There were no differences between the two groups in creatinine clearance at any time. A control renal biopsy, taken from patients with stable renal function after 6-12 months, showed only mild abnormalities. The lesions were semiquantitatively assessed. There was a higher score for interstitial infiltrate in patients on triple therapy (P less than 0.05). On the other hand, the incidence and the mean score of interstitial fibrosis were greater in patients on double therapy, although these differences were not significant. Thus, although similar results were obtained with both regimens, at the doses we used double therapy seems to have more powerful immunosuppressive effects and may prevent rejection, either acute or chronic, better. However, it might expose the patient to a greater risk of infection and of cyclosporine-related nephrotoxicity than triple therapy.

Acute Kidney Injury↗