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Biomedical subjects

Paul E Morrissey

Publications and source records attributed to Paul E Morrissey.

8 recordsLinked to original sources
PubMed2006

Utility of a mathematical nomogram to predict delayed graft function: a single-center experience.

BACKGROUND: In 2003, Irish and colleagues published a weighted nomogram designed to predict the risk of delayed graft function (DGF) in a given transplant. It was anticipated that the predictive nomogram would permit preemptive therapies or allocation decisions based on the risk of DGF. The potential for reducing unfavorable outcomes and expenses appeared significant. This nomogram, however, was developed using population data found in the United States Renal Data System and has not been prospectively validated. METHODS: We evaluated the accuracy and utility of this nomogram in all cadaver renal transplants performed at a single transplant center. In addition, we correlated DGF with a variety of independent donor and recipient variables outside the established nomogram. RESULTS: The average nomogram DGF risk was 0.41 (a 41% chance of DGF) among the 169 cases in our population. The mean was 0.45+/-0.14 (confidence interval: 0.40-0.49) for the 42 DGF-positive subjects, and 0.40+/-0.14 (confidence interval: 0.38-0.43) for the 127 DGF-negatives (t=1.80; P=0.07). CONCLUSIONS: Although there was a trend showing the predictive value of the nomogram the overlap was tremendous, limiting the accuracy of the calculation for any single recipient. Prospective application of a nomogram on a case-by-case basis did not contribute meaningful information that could guide clinical decision-making regarding use, allocation or immunosuppressive regimen aimed at minimizing DGF.

Adult↗
PubMed2006

Renal transplantation: older recipients and donors.

The majority of patients receiving a renal allograft, including a kidney from an older donor, do well. Renal transplantation from a living donor is associated with distinct advantages, including prolonged allograft survival. When live donors are not available, however, deceased donor kidneys provide suitable renal function that frequently lasts the lifetime of elderly recipients. Elderly patients who receive a kidney transplant enjoy improved survival, better quality of life, and lower medical costs than those who remain on dialysis.

Age Factors↗
PubMed2006

Living kidney donation: evolution and technical aspects of donor nephrectomy.

For more than 40 years, living donor nephrectomy was performed through a flank incision drawn on the urologic experience with nephrectomy for cancer. Since its introduction one decade ago, laparoscopic donor nephrectomy has gained widespread acceptance and popularity; currently over one-half of donor nephrectomies in the United States are performed with this technique. The changing practice of donor nephrectomy resembles in many ways the evolution of minimally invasive in other subspecialties. The lessons learned from these technical developments are valuable and can be adapted by general surgeons and urologists when called upon to perform nephrectomy for organ donation or kidney disease.

Humans↗
PubMed2006

Use of an immune function assay to monitor immunosuppression for treatment of post-transplant lymphoproliferative disorder.

The first-line treatment for PTLD is reduction in immunosuppression, allowing partial reconstitution of cell-mediated immunity. However, there is a risk of inducing acute allograft rejection during clinical resolution of PTLD. A recently available assay, Immuknow, measures the cell-mediated immune response and could be used to monitor reduction of immunosuppression. We report a case of PTLD occurring in a pediatric kidney transplant recipient where the reduction in immunosuppression was serially followed using this assay and quantitative EBV-PCR. A rapid reduction to minimal immunosuppression was followed by resolution of PTLD. Later, when the cell-mediated immune response increased, with negative viral load, immunosuppression was gradually increased utilizing the assay to adjust dosing. Presently, there are no signs of PTLD and renal function remains normal.

Child, Preschool↗
PubMed2004

Renal transplant survival from older donors: a single center experience.

HYPOTHESIS: Despite the observation that kidney transplantations from older donors have an increased risk of failure, the percentage of kidney donors 55 years and older has increased. We explored the risk of allograft failure in a single transplantation center with older (55-79 years) vs younger (18-54 years) donors. DESIGN: Retrospective cohort review with a mean follow-up of 32 months. SETTING: Academic transplant center. PATIENTS: Consecutive recipients (n = 324) of renal transplants from adult donors. INTERVENTIONS: Patients were divided into 4 groups based on donor status (living or deceased) and donor age (< or =54 or > or =55 years). MAIN OUTCOME MEASURES: Allograft survival and function, incidence of acute rejection. RESULTS: Recipients of older donor kidneys were significantly older (53.6 vs 43.6 years, P<.001). Seven allografts (12.7%) failed from 55 transplants from donors 55 years and older, compared with 41 allografts (15.2%) from 269 younger donors (P =.63). Renal function was superior following renal transplantation using younger donors (P =.004). However, renal function was acceptable in all groups, with a mean +/- SD serum creatinine level of 1.7 +/- 0.4 mg/dL (150 +/- 35 micro mol/L) among recipients of older donor kidneys. Allograft survival at 1, 2, and 3 years, censored for death with allograft function, did not differ when comparing older vs younger donors. CONCLUSIONS: Most patients receiving allografts from older donors do well. Older donor kidneys provide suitable renal function for many patients on dialysis awaiting transplantation.

Adolescent↗
PubMed2004

Donor kidney exchanges.

Kidney transplantation from live donors achieves an excellent outcome regardless of human leukocyte antigen (HLA) mismatch. This development has expanded the opportunity of kidney transplantation from unrelated live donors. Nevertheless, the hazard of hyperacute rejection has usually precluded the transplantation of a kidney from a live donor to a potential recipient who is incompatible by ABO blood type or HLA antibody crossmatch reactivity. Region 1 of the United Network for Organ Sharing (UNOS) has devised an alternative system of kidney transplantation that would enable either a simultaneous exchange between live donors (a paired exchange), or a live donor/deceased donor exchange to incompatible recipients who are waiting on the list (a live donor/list exchange). This Regional system of exchange has derived the benefit of live donation, avoided the risk of ABO or crossmatch incompatibility, and yielded an additional donor source for patients awaiting a deceased donor kidney. Despite the initial disadvantage to the list of patients awaiting an O blood type kidney, as every paired exchange transplant removes a patient from the waiting list, it also avoids the incompatible recipient from eventually having to go on the list. Thus, this approach also increases access to deceased donor kidneys for the remaining candidates on the list.

Cadaver↗
PubMed2002

Management of thrombophilia in renal transplant patients.

Renal allograft recipients with thrombophilia (a hypercoagulable state) are at higher risk for early allograft loss. Following an episode of allograft renal vein thrombosis in a patient subsequently diagnosed with protein C deficiency, we adopted universal screening for hypercoagulable risk factors. Patients with a history of a thromboembolic event underwent laboratory screening for thrombophilia. Eight patients with a defined hypercoagulable disorder or a strong clinical history of thrombosis even in the absence of hematologic abnormalities were treated with anticoagulation following renal transplantation. We reviewed the outcomes of these eight patients and all renal transplant recipients at our center who developed thrombotic complications after renal transplantation. Since the introduction of universal screening for hypercoagulable risk factors, 235 consecutive transplants were performed without allograft thrombosis. Eight patients with evidence of thrombophilia, recognized before renal transplantation, received perioperative heparin and postoperative oral anticoagulation. Two of these eight patients developed perinephric hematomas requiring evacuation, blood transfusion, and temporary withholding of anticoagulation. Of interest, two of the remaining 227 patients, not identified with thrombophilia before surgery, developed thrombotic complications after renal transplantation. A hypercoagulable disorder was subsequently documented in each. Identifying patients with thrombophilia before transplantation and defining their management presents many challenges. The risk of allograft thrombosis must be weighed against the risk of perioperative bleeding and the need for long-term anticoagulation. Recommendations for managing thrombophilia in renal transplant recipients are suggested based on our experience and review of the literature.

Anticoagulants↗