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Biomedical subjects

P J Friend

Publications and source records attributed to P J Friend.

At least 73 records · Page 4Linked to original sources
PubMed1994

Liver transplantation for hepatic cirrhosis in cystic fibrosis.

Five children with cystic fibrosis complicated by hepatic cirrhosis received liver grafts. They all had portal hypertension with varices and three had variceal bleeding; respiratory function was only moderately impaired, but four were colonised with pseudomonas and one with aspergillus. Liver transplantation was well tolerated and there was no increase in respiratory or other early postoperative complications. Four of the children were fully well from 14 to 35 months after transplantation; the most recently transplanted had problems from a biliary stricture. In spite of the need for immunosuppression there was no increase in infection and respiratory function improved or remained stable. Once the children were stabilised after transplantation their nutrition and general health were greatly improved.

Adolescent↗
PubMed1992

Assessment of costs to donor hospitals for organ transplantation.

In 1987, die Department of Health in the UK set up a working party to identify reasons contributing to a shortfall in donor organs. One recommendation was reimbursement to the District Health Authorities for costs incurred in providing the donor organs. The figure chosen was not to be seen as an incentive to donate organs, merely as an appropriate compensation for the costs incurred. There would be no direct payment to doctors, trustees or relatives of the donor. With the development of the competitive health care environment in the United Kingdom, the reimbursement of donating hospital costs is being considered with these data.

Costs and Cost Analysis↗
PubMed1991

Graft-versus-host disease in solid organ transplantation.

Graft-versus-host disease is well recognized in bone marrow transplantation, but has only recently been described in solid organ transplantation. Two such cases in liver graft recipients, proven by the demonstration of donor type HLA antigens in the peripheral blood and marrow on tissue typing, are described in this paper. The literature on this subject is reviewed and the treatment discussed. It is postulated that there is an order of risk of development of graft-versus-host disease depending on the amount of viable lymphoid tissue included with the transplanted organ as follows: small bowel greater than heart-lung greater than liver greater than kidney greater than heart. It seems likely that this condition has been substantially underdiagnosed in the past and that greater awareness of the possibility of graft-versus-host disease in solid organ recipients will lead to the recognition of further cases and allow appropriate treatment to be promptly instituted.

Adult↗
PubMed1991

Orthotopic liver transplantation at Addenbrooke's Hospital Cambridge 1968 to 1991.

Liver grafting is now established as the optimal treatment for patients with end-stage parenchymal liver disease. Twenty-three years of experience at a single center is presented. The 1-year actuarial patient survival rate for all cases transplanted in Cambridge has now risen from 10% in 1968 to 1970 to 80% in 1990 to 1991. Increasing numbers of patients are being referred for transplantation with an ever-increasing range of indications being developed. Many inborn errors of metabolism can now be cured by liver grafting. There is still, however, considerable scope for improvement in many areas of patient treatment from operative and postoperative care to long-term immunosuppressive management. Much remains to be done to minimize early sepsis- and rejection-related deaths and late immunosuppression-related morbidity.

Actuarial Analysis↗
PubMed1991

Monoclonal antibodies in immunosuppression.

Experimental and clinical studies have been carried out to investigate the application of a number of monoclonal antibodies which recognise human lymphocytes in clinical organ transplantation. Where possible, preliminary studies have been carried out using a primate renal allograft model before proceeding to clinical pilot studies. The Campath-1 antigen (CDW52) appears to be a good target for antilymphocytic therapy; a powerful immunosuppressive effect has been demonstrated using both IgM and IgG2b antibodies which recognise this antigen. An IgG2b antibody which recognises the IL-2 receptor was shown to be immunosuppressive in the primate model but clinical studies have, as yet not demonstrated a significant, beneficial effect in preventing rejection. Patients who receive antilymphocyte monoclonal antibodies require monitoring of the expression of the target antigen, the level of free antibody in serum and the development of an antiglobulin response. The current issues in the use of antilymphocyte monoclonal antibodies in clinical immunosuppression include identification of the optimum target, interaction of the antibody with recipient effector mechanisms and methods to avoid or suppress the antiglobulin response.

Animals↗