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Biomedical subjects

P F Foster

Publications and source records attributed to P F Foster.

30 records · Page 2Linked to original sources
PubMed1991

Technique for splanchnic transplantation.

The combination of short-bowel syndrome and liver failure in infancy is inevitably fatal. We describe the details of a technique for simultaneous implantation of both the bowel and the liver that leaves the native bowel undisturbed and avoids entering the gastrointestinal tract. The conceptual basis on which this procedure was performed in two infants is presented.

Humans↗
PubMed1991

Morphometric inflammatory cell analysis of human liver allograft biopsies.

To quantitate the inflammatory cell response within the portal tracts of liver allografts during acute rejection, we retrospectively and in a blinded fashion reviewed 431 biweekly, protocol, core allograft biopsies in 58 consecutive adult recipients. Following the determination of the cross-sectional area of each portal tract, the number of eosinophils, neutrophils, and lymphocytes therein was tabulated. The average number, percentage, and density of each type of portal inflammatory cell were calculated for each biopsy. Each biopsy was prospectively and independently classified as either associated (REJ+) or not associated (REJ-) with acute rejection. Acute rejection consisted of simultaneous allograft dysfunction and qualitative pathologic findings of acute rejection. Biopsies obtained during periods of normal allograft function or during episodes of dysfunction due to other causes were classified as not associated with rejection (REJ-). Ninety biopsies were classified as associated with acute rejection (REJ+) while 241 biopsies were classified as not associated with acute rejection (REJ-). In general, the average portal-tract number, percentage, and density of all inflammatory cells were significantly increased in biopsies associated with acute rejection. In contrast, only the portal-tract eosinophil values were consistently predictive of acute rejection following receiver-operating characteristic curve analysis (sensitivity = 82-86%, specificity = 91-92%). This quantitative method of allograft assessment appears to improve the objectivity of the serial biopsy protocol. By using this method, we found the eosinophil's appearance within the portal tracts to be a dependable indicator of acute rejection.

Adult↗
PubMed1991

Eosinophil cationic protein's role in human hepatic allograft rejection.

Although it is known that eosinophils consistently infiltrate rejecting human liver allografts, their function is unknown. Infiltrating eosinophils can release a cytotoxic substance, eosinophil cationic protein. Furthermore, eosinophil cationic protein may be identified in biopsy specimens using immunoperoxidase staining of an eosinophil cationic protein-specific monoclonal antibody. To study a possible effector role of eosinophils in rejecting liver allografts, 38 serial allograft biopsy specimens from 12 patients with acute rejection, 54 biopsy specimens from 11 patients with allograft dysfunction caused by other causes and 22 biopsy specimens from 8 patients without allograft dysfunction were stained for extracellular eosinophil cationic protein. In addition, the absolute blood eosinophil counts and the portal tract eosinophil percent of the total number of portal tract inflammatory cells were tabulated in these patients until 30 days after transplantation. The blood absolute eosinophil count, portal tract eosinophil percent and incidence of positive extracellular eosinophil cationic protein staining were significantly increased in patients with rejection compared with patients with dysfunction from other causes (p less than 0.05 to 0.005, t test). Furthermore, each of these parameters predicted rejection with excellent sensitivity (75% to 92%) and specificity (91% to 100%). Of patients with rejection, 59% had significant elevation of all three parameters before or during rejection, and 92% had at least two parameters elevated. Conversely, of the patients with dysfunction from other causes, 0% had elevations of any parameter. The recognized cytotoxic properties of eosinophil cationic protein and its almost exclusive presence, along with eosinophils in the blood and allograft biopsy specimens of patients during acute rejection, support the role of the eosinophil as an effector cell in tissue injury during acute liver allograft rejection.

Blood Proteins↗
PubMed1989

Splanchnic transplantation. An approach to the infant dependent on parenteral nutrition who develops irreversible liver disease.

Two infants with short-bowel syndrome and liver failure associated with obligatory parenteral nutrition received a composite allograft that consisted of en bloc liver, stomach, duodenum, pancreas, jejunum, and ileum. Solutions to the fatal complications in the first case resulted in a functioning composite splanchnic system in the second case. Despite a number of early complications, the small intestine and liver developed near-normal function until a monoclonal, malignant, B-cell lymphoproliferative disorder appeared. The analysis of these two cases supports three summary observations: the operative procedure can be safely performed in a metabolically compromised infant; intestinal allograft rejection, in this model, is controllable with existing immunosuppressive drugs; and this procedure appears to be associated with a uniquely high incidence of lymphoma. Since transplantation is a feasible solution to this devastating infantile disease, further development of this therapy must incorporate means of preventing lymphoma.

Cyclosporins↗
PubMed1989

Blood and graft eosinophilia as predictors of rejection in human liver transplantation.

This study attempts to define the relationship of blood and graft eosinophilia to acute hepatic allograft rejection. Sixty liver transplant patients were studied for the first 30 days postoperatively, with daily serum bilirubin and liver enzyme levels, white blood cell counts and differential counts, and biweekly core liver biopsies. Graft eosinophilia was established if 7% or greater of the cells infiltrating the portal triads were eosinophils. Blood eosinophilia is an absolute eosinophil count greater than 500 cells/mm3 occurring on any of the 5 days preceding the day of rejection. Acute rejection was diagnosed when 2 days of hepatic allograft dysfunction occurred with histologic evidence of rejection. The 2nd day of dysfunction with appropriate histologic findings was arbitrarily chosen as the day of rejection. Graft eosinophilia predicted rejection with 92% sensitivity and 98% specificity. Blood eosinophilia occurred on the average on the day of rejection and on the 2 preceding days, while graft eosinophilia occurred on the day of rejection and on 1 preceding day. Blood eosinophilia followed by graft eosinophilia specifically occurred in cases of rejection. Blood eosinophilia not followed by graft eosinophilia was not associated with rejection. Following treatment of rejection with high-dose corticosteroids, blood and graft eosinophil counts decreased markedly. In summary: (1) graft eosinophilia is very sensitive and specific for acute hepatic allograft rejection; (2) blood eosinophilia closely precedes and parallels graft eosinophilia specifically during acute hepatic allograft rejection; and (3) elevated blood and graft eosinophil counts are markedly reduced following treatment of rejection with high-dose corticosteroids.

Eosinophilia↗