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Biomedical subjects

P McMaster

Publications and source records attributed to P McMaster.

287 records · Page 16Linked to original sources
PubMedDate not supplied

Biliary beta 2-microglobulin in liver allograft rejection.

beta 2-Microglobulin, which is associated with HLA class 1 antigens, was assayed in bile and serum from 19 patients following 22 liver transplants. Serum levels were elevated in all posttransplant patients irrespective of the presence of rejection. In contrast, biliary levels were significantly higher during episodes of acute rejection compared with posttransplant cholangitis (p less than 0.01), stable graft function (p less than 0.0001) and nontransplant samples (p less than 0.0001). When bile/serum ratios were studied, the difference between the rejection and the other groups was even more significant, and if a ratio of 0.2 was considered diagnostic of rejection, the test had a sensitivity of 96%, a specificity of 87% with an accuracy of 90%. Therefore, these results suggest that the measurement of bile/serum ratios of beta 2-microglobulin following liver transplantation may be useful in diagnosing acute rejection. When bile/serum ratios of beta 2-microglobulin were compared with those for other proteins, there was strong evidence to suggest that local release accounted for most of the increased biliary beta 2-microglobulin during rejection. These results provide further evidence that HLA class 1 antigens on the biliary epithelium may be important in liver allograft rejection.

Albumins↗
PubMedDate not supplied

Hematologic problems and organ transplantation.

Disturbances in blood coagulation profiles combined with intraoperative technical problems may lead to hemorrhage and significant blood loss. During the postoperative period hematologic changes may result from the use of immunosuppressive drugs, so careful monitoring and review are essential parts of management. The two major aspects of hematologic change are reviewed.

Hematologic Diseases↗
PubMedDate not supplied

Cyclosporin A in patients receiving renal allografts from cadaver donors.

Seven patients on dialysis with renal failure received transplants from mismatched cadaver donors and were treated with cyclosporin A (CyA), initially as the sole immunosuppressive agent. CyA was effective in inhibiting rejection but there was clear evidence of both nephrotoxicity and hepatotoxicity. A cyclophosphamide analogue was added to the CyA treatment in six of the patients. Five patients are out of hospital with functioning allografts, and two of these have received no steroids. One patient required an allograft nephrectomy because of pyelonephritis in the graft. Another died of systemic aspergillus and candida infection. Further careful study of this potentially valuable drug will by required before it can be recommended in clinical practice.

Acute Disease↗
PubMedDate not supplied

Type 1 diabetes mellitus in children in Papua New Guinea.

Anecdotal and published information suggest a low incidence and prevalence of type 1 diabetes in Papua New Guinea (PNG). Incidence and prevalence were followed prospectively from July 1996, using the PNG Paediatric Surveillance Unit (PSU). No children were receiving insulin in Papua New Guinea at the start of the period. Over the next 4.5 years, 8 cases were reported--an annual incidence of 0.08/100,000 children aged < 15 years and a prevalence of 0.28/100,000 aged < 15 years. These figures are as low as any reported elsewhere. Three cases were from the small expatriate population. All cases in Melanesian children posed significant management problems, with two children dying during the study period.

Child↗
PubMedDate not supplied

Combined liver-spleen-small intestine grafting in a rat model: role of transplanting additional lymphoid tissue on survival.

The aim of this study was to develop suitable models of combined intestinal grafting to examine the enhancing effect of intestinal grafting with additional lymphoid tissue using 30% of the liver mass and the whole spleen on recipient survival in the absence of immunosuppression. Grafts from DA (RT1a) rats were transplanted orthotopically to PVG (RT1(1)) recipients according to the following design: group 1 (n = 6), en bloc 30% liver/entire SB/spleen; group 2 (n = 7), en bloc 30% liver/SB; group 3 (n = 7), SB/spleen and group 4 (n = 7), SB control for the preceding groups. The orthotopic nature and proximal interposition of the SB graft allowed the assessment of protection afforded by components of the cluster on the SB graft using survival endpoints. Although group 4 hosts survived half as long compared to other groups, statistical significance was reached only in the case of group 1; group 1 MST equalled 15.3 days, significantly higher than group 4 (p = 0.01). Acute rejection was present in every grafted tissue and was equivalent whether liver was included or excluded in the cluster. GVHD was absent postoperatively using clinical or histological criteria; recipient spleens showed hyperplasia, donor spleens depicted lymphocytic depletion on histology. This study determined that statistically proven enhanced survival was obtained only after grafting 30% liver plus spleen with the entire SB. GVHD was rare in the fully allogeneic system despite transplanting a massive load of lymphoid tissue. The surgical models used in this study employing liver in the cluster, address the important question of how best to evaluate the role of heterotopic accessory liver grafting in providing tolerance to co-transplanted small intestine.

Animals↗