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Biomedical subjects

L H Banowsky

Publications and source records attributed to L H Banowsky.

At least 19 recordsLinked to original sources
PubMed1989

Evaluation of pediatric cadaver kidneys transplanted into adult recipients receiving cyclosporine.

The major problem in clinical transplantation is the imbalance between the need for cadaveric organs and the available numbers of donors. If pediatric kidneys were transplanted into adult recipients when no pediatric recipient was available, the potential number of renal donors would be increased by 15 to 20%. Some centers are reluctant to use pediatric kidneys for adult recipients because of recent reports indicating poorer patient and allograft survival, increased delayed graft function, increased post-transplant hypertension and increased technical complication. (There also has been concern that the nephrotoxic effect of cyclosporine A would retard the organ growth that is necessary to provide normal renal function in adults.) A retrospective analysis was performed on 18 adult recipients who received kidneys from cadaver donors 14 months to 12 years old (group 1). These patients were compared to 106 adult recipients who received kidneys from donors greater than 12 years old (group 2). Actuarial patient survival at 1 year was 85% for group 1 and 95.8% for group 2 (p equals 0.13), while 1-year actuarial allograft survival was 83.1% for group 1 and 81.1% for group 2 (p equals 0.87). There was no significant difference between groups 1 and 2 in the frequency of delayed graft function, serum creatinine at 1, 3 and 6 months after transplantation, incidence of post-transplant hypertension or frequency of surgical complications. It is of interest that the pediatric kidneys had significant growth during the initial post-transplant month. Sonographic examination at postoperative days 1 and 30 demonstrated a mean increase in size from 80.7 to 143.5 cm. (p less than 0.001). In this series pediatric kidneys were safe and effective donor organs in adult recipients, and increased the available number of organs by 15%.

Adolescent↗
PubMed1989

Conventional immunosuppression after deliberate third party transfusions versus cyclosporine in living related renal transplant recipients.

A total of 93 recipients of either HLA-identical (34) or 1-haplotype matched (59) living related donor renal transplants was assigned prospectively into immunosuppressive treatment groups on the basis of transfusion histories obtained at the initial evaluation for transplantation. Patients who received 0 to 2 third party transfusions were given no further transfusion, and received cyclosporine and prednisone immunosuppression after transplantation (cyclosporine group). Patients who received 3 or 4 third party transfusions were given additional transfusions until 5 had been received, and were managed with azathioprine and prednisone after transplantation (azathioprine group). Patients who already received 5 or more third party transfusions had no additional transfusions and were assigned to the azathioprine group. No patient had a positive crossmatch to the potential donor after initial evaluation and confirmation of a negative crossmatch. The number of rejection episodes per patient after transplantation was significantly higher in the azathioprine group for HLA-identical (p equals 0.001) and 1-haplotype (p equals 0.003) recipients. One-year patient survival rats for the HLA-identical cyclosporine and azathioprine groups were 100 and 94 per cent, respectively, with respective 1-year allograft survivals of 100 and 89 per cent in the 2 groups. In the 1-haplotype group 1-year patient survival rates were 95 and 94 per cent for the cyclosporine and azathioprine groups, respectively; allograft survival was 81 per cent for the cyclosporine group and 91 per cent for the azathioprine group. None of the observed differences in graft or patient survival between the 2 groups was statistically significant. Deliberate third party transfusions with conventional immunosuppression and cyclosporine immunosuppression are effective methods to treat recipients of living related donor renal transplants.

Adult↗
PubMed1985

Upper gastrointestinal bleeding following renal transplantation.

Upper gastrointestinal bleeding has been shown to be a common complication of renal transplantation and one which carries a significant risk of mortality. In a retrospective review of 200 consecutive renal transplants in 194 patients, we found an incidence of only 6 per cent and a mortality rate of 8.3 per cent. Allograft survival in this group of patients was 58 per cent. These results are the product of careful preoperative evaluation, close attention to the patients for early signs of bleeding, and aggressive diagnostic and therapeutic intervention at the first evidence of bleeding. We also report an association of hypercalcemia with post-transplant upper gastrointestinal bleeding, with cessation of bleeding after parathyroidectomy.

Antacids↗
PubMed1984

Hypercalcemia-induced upper gastrointestinal bleeding after renal transplantation.

Hypercalcemia is common in patients after renal transplantation and may stimulate gastrin hypersecretion with associated peptic disease. We report on 2 patients with hypercalcemia and life-threatening gastrointestinal hemorrhage controlled by subtotal parathyroidectomy. Retrospective review of our last 10 patients with gastrointestinal hemorrhage revealed that all of those with normal renal function had elevated serum calcium levels. Because of the increased mortality associated with gastrointestinal hemorrhage in renal transplant patients (43%), patients prone to development of hypercalcemia may benefit from early subtotal parathyroidectomy.

Adult↗
PubMed1984

Plasmapheresis--adjunctive treatment for steroid-resistant rejection in renal transplantation.

Plasmapheresis was used to treat steroid-resistant rejection in 32 of 154 patients (21.1 per cent) receiving renal allografts during a 3 1/2-year interval. The 2-year actuarial patient and allograft survival rates for the 32 patients were 93.3 plus or minus 5 and 56.9 plus or minus 9 per cent, respectively. Mean patient followup was 18.8 months. No immunologic rebound was noted in any of the 19 patients who responded initially to plasma exchange. Although 14 of these 19 patients had peak creatinine levels of 4 to 14.5 mg. per cent during the rejection reactions significant and sustained improvement in renal function was noted. This was not a controlled trial but the results are sufficiently encouraging to warrant continued evaluation of plasmapheresis as a therapeutic adjuvant in the treatment of humoral or steroid-resistant rejection.

Adolescent↗
PubMed1984

Basic microvascular techniques and principles.

This article will discuss the advantages and disadvantages of the various types of optical magnification currently available. The instruments necessary for performing most operations will also be presented. Attention will be focused on the physical properties and technical considerations of microvascular anastomosis. The principles and techniques employed for joining small blood vessels are almost always valid and transferable to reconstructive surgery of other small tubes such as the ureter, bowel, etc.

Animals↗
PubMed1984

Survival of cadaveric renal allografts in Hispanic as compared with Caucasian recipients.

Evaluation of allograft survival rates revealed a significantly better overall graft survival in Hispanic (n = 66) as compared with Caucasian (n = 38) recipients of primary cadaveric renal transplants. There were no significant differences between the Hispanic and Caucasian cadaveric recipient groups in terms of patient survival, pretransplant transfusion status, immunosuppressive protocols, rejection therapy, mean age, or frequency of diabetes mellitus. Cadaveric donor ethnic origin (i.e., Caucasian or Hispanic) did not significantly alter graft survival rates in either recipient ethnic group. Although Caucasian patients with splenectomies had better cadaveric graft survival than Caucasian graft recipients without splenectomies (P = .02), splenectomy had no significant effect on the renal allograft survival rate in Hispanics. Other factors that were evaluated and found not to correlate significantly with cadaveric graft survival rates were donor recipient HLA matching (A, B, or DR), and panel reactivities of recipient pregraft serum samples. In contrast to the superior cadaveric renal allograft survival in Hispanic as compared with Caucasian recipients, 1-haplotype-matched or 2-haplotype-matched living-related renal allografts had comparable graft survival rates in Caucasian and Hispanic recipients. These results indicate that Hispanics without splenectomy enjoy a cadaveric renal allograft survival rate superior to nonsegregated populations (treated with conventional immunosuppression) reported elsewhere.

Age Factors↗
PubMed1983

Effect of pretransplant blood transfusions and splenectomy on renal allograft survival in the Lewis rat.

Both pretransplant blood transfusions and pretransplant splenectomy have been shown to improve renal allograft survival in humans and experimental animals. A study was undertaken using the Lewis rat to determine if any combination of pretransplant splenectomy and pretransplant blood transfusions exerted either a synergistic or deleterious effect on renal allograft survival. Pretransplant splenectomy and pretransplant blood transfusions used singly significantly prolonged renal allograft survival. Pretransplant splenectomy followed by 3 blood transfusions also significantly prolonged renal allograft survival. This finding implies that secondary sites of suppressor cell activity, for instance lymph nodes, can be stimulated by blood transfusion and produce prolonged allograft survival in the absence of the spleen. No combination of pretransplant blood transfusion and splenectomy was synergistic. In fact, the group that had pretransplant transfusions followed by splenectomy had allograft survival no different from the control group.

Animals↗
PubMed1982

Head and neck infection after renal transplantation.

Infections of the head and neck were identified in 12 (9%) of 128 consecutive patients undergoing renal transplantation. The infections included sinusitis, otitis media, dental abscess, Ludwig's angina, parotitis, and nasal abscess. A significant correlation was found between the development of infection and juvenile-onset diabetes but not with previous splenectomy. None of the infections occurred during treatment of rejection episodes with corticosteroids. The clinical presentations and microbiologic agents causing the infections were similar to those found in nonimmunosuppressed patients.

Adult↗
PubMed1982

Patient survival in cadaveric renal transplantation: report from a small center.

Recipients of cadaveric kidney transplants before 1975 had a 1-year mortality rate (30 per cent) approximately 3 times higher than patients on chronic hemodialysis (10 per cent). Patient survival was no better in large than in small transplant centers. Since 1975 several large and experienced transplant centers (more than 500 transplants) have reported improved patient survival rates (90 per cent). We herein document that a small transplant center (less than 200 transplants) can achieve patient survival rates that are equivalent to larger transplant centers.

Adolescent↗
PubMed1981

Pretransplant bilateral nephrectomy and adjuvant operations.

Pretransplant bilateral nephrectomy by the posterior approach has been associated with minimal morbidity and mortality. Unfortunately the posterior approach is not applicable to all patients, e.g., patients with polycystic renal disease or patients who need simultaneously another intraperitoneal adjuvant operation such as splenectomy or vagotomy and pyloroplasty. This article presents 34 patients who had a transperitoneal bilateral nephrectomy and 29 other concurrent adjuvant operations. Morbidity and mortality are comparable to that reported for simple bilateral nephrectomy performed posteriorly. The reduction in morbidity and mortality was believed to be due to a careful application of the basic principles of surgical care and an appreciation of the special problems posed by patients on chronic hemodialysis. Perioperative care will be discussed in detail.

Adolescent↗
PubMed1981

HLA frequencies in a Mexican American population.

HLA-A and -B antigens were determined for 300 unrelated Mexican-Americans and 300 unrelated Caucasians from San Antonio by the microlymphocytotoxicity technique, using lymphocytes isolated from freshly drawn peripheral blood. Haplotype frequencies for the Mexican American population were obtained directly, based on family studies, as well as estimated from phenotype data. The results revealed clear differences in the distribution of HLA antigens between Mexican American and Caucasian populations. The predominant HLA specificities in Mexican Americans were A2 and Bw35, while the most frequently observed haplotypes were A2-Bw35, A2-B12 and A2Bw40. Despite the distinct differences in HLA antigen distribution between Mexican American and Caucasian populations, genetic distance values, calculated from the HLA frequencies, were surprisingly low.

Epitopes↗