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R J Corry

Publications and source records attributed to R J Corry.

At least 37 records · Page 2Linked to original sources
PubMed1997

Spontaneous arterioenteric fistula after pancreas transplantation.

Chronic pancreas transplant rejection with enteric exocrine drainage can lead to significant long-term complications. We report a case of a 47-year-old male insulin-dependent diabetic who survived the complications of peripancreatic abscess, enterocutaneous fistula, and arterioenteric fistula related to pancreas transplantation. To avoid these long-term complications, we now recommend elective removal of nonfunctioning, enterically drained pancreas allografts.

Anastomosis, Surgical↗
PubMed1995

Combined simultaneous kidney/bone marrow transplantation.

On the basis of observations in patients with long-term (28-30 years) renal allograft survival, all of whom had evidence of systemic microchimerism, we began a program of combined simultaneous kidney/bone marrow transplantation. Between 12/14/92, and 10/31/94, 36 kidney transplant recipients received 3-5 x 10(8) unmodified bone marrow cells/kg; 6 patients also received pancreatic islets, and 7 patients also received a pancreas. The mean recipient age was 39.0 +/- 10.8 years, and the mean donor age was 31.8 +/- 16.1 years; the mean cold ischemia time was 23.0 +/- 9.1 hr. Twenty control patients received kidneys alone, mainly because of refusal by the donor family to consent to vertebral body recovery; 3 of these patients also received a pancreas. The mean recipient age was 47.9 +/- 11.7 years, and the mean donor age was 41.5 +/- 17.9 years; the mean cold ischemia time was 28.6 +/- 6.2 hr. All patients received tacrolimus-based therapy, without radiation, cytoreduction, or induction antilymphocyte preparations. Blood was drawn prior to and at regular intervals after transplantation for detection of chimerism and for immunologic studies. With a mean follow-up of 11.1 +/- 5.8 months, all 36 study patients are alive, and 33 (92%) have functioning allografts with a mean serum creatinine of 1.9 +/- 1.2 mg/dl and a BUN of 26 +/- 9 mg/dl. Graft vs. host disease was not seen in any patient. The incidence of rejection was 72%; 11% of the patients required OKT3 or ATG for steroid-resistant rejection. The incidence of CMV was 14%, and that of delayed graft function was 17%. A total of 18 (90%) control patients are alive, and 17 (85%) have functioning allografts, with a mean serum creatinine of 2.1 +/- 1.3 mg/dl, and a BUN of 30 +/- 13 mg/dl. The incidence of rejection was 60%, and 10% required OKT3 or ATG. CMV was seen in 15%, and delayed graft function in 20% (P = NS). In the study patients, chimerism was detected in the peripheral blood of 30 of 31 (97%) evaluable patients by either PCR or flow cytometry. In the control patients, chimerism was seen in 9 of 14 (64%) evaluable patients (P < .02). Decreasing donor-specific responsiveness was seen in 6/29 (21%) evaluable study, and 4/14 (29%) evaluable control patients (P = NS). We conclude that combined kidney/bone marrow transplantation is associated with acceptable patient and graft survival, augmentation of chimerism, and no change in the early events after transplantation.

Adolescent↗
PubMed1995

The superiority of tacrolimus in renal transplant recipients -- the Pittsburgh experience.

Tacrolimus is a superior immunosuppressive agent in patients undergoing renal transplantation. In adults, the 1- and 3-year actuarial patient survivals were 95% and 92%, and the 1- and 3-year actuarial graft survivals were 89% and 80%. For first cadaver kidneys, the 1- and 3-year actuarial graft survivals were 91% and 82%, with a projected half-life of 11.9 years. Sixty-nine percent of successfully transplanted patients were weaned off steroids. In pediatric patients, the 1- and 4-year actuarial patient survivals were 100% and 96%, and the 1- and 4-year actuarial graft survivals were 99% and 85%. Seventy-three percent of successfully transplanted children were weaned off steroids. Tacrolimus was also useful as a rescue agent, with an initial success rate of 74%. Tacrolimus has been used successfully in kidney/ pancreas transplantation, with 100% patient, 95% kidney, and 79% pancreas graft survival. Tacrolimus should be considered the immunosuppressive agent of choice in renal transplantation.

Adolescent↗
PubMed1994

Markers for pancreatic allograft rejection: comparison of serum anodal trypsinogen, serum amylase, serum creatinine and urinary amylase.

Currently, the markers of acute rejection in pancreas allografts are not consistently reliable. The purpose of this study was to evaluate the ability of sAT to predict acute rejection as compared to serum creatinine (sCr), urinary amylase (uAmy) and serum amylase (sAmy). Eleven first-time acute rejection episodes in bladder-drained SPK recipients were studied. All rejection episodes were biopsy-proven (core kidney 9, fine needle kidney 2, fine needle pancreas 5). Sera obtained from days -7 to -1 (pre-treatment), day 0 (start of anti-rejection treatment), and +1 to +7 (post-treatment) periods were analyzed. Peak median sAT and sAmy levels occurred at day 0 compared to day 1 for sCr. uAmy trough levels occurred on days -4, -5 and +2. The difference between pre-treatment levels and those on day 0 were significant for sAT, sAmy and sCr but not for uAmy. Only in the case of sAT was the difference between day 0 levels and post-treatment levels significant. Both sAmy (0.87) and sCr (0.85) demonstrated positive correlation when compared to sAT whereas uAmy demonstrated a weak negative correlation (-0.24). This study confirms that sAT accurately predicts rejection after SPK transplantation.

Amylases↗
PubMed1994

Simultaneous pancreas-kidney versus kidney-alone transplants in diabetics: increased risk of early cardiac death and acute rejection following pancreas transplants.

The decision between a simultaneous pancreas-kidney (SPK) or kidney-alone (KA) transplant for the treatment of diabetic end-stage renal disease depends on the risk-versus-benefit of each procedure. In this study we compared the mortality, morbidity, graft function and acute rejection after 88 SPK and 65 KA transplants. All acute rejection episodes were biopsy-proven. Patient survival was higher in the KA group (KA 92%, SPK 83%) at 1 year, but similar in both groups at 5 years (SPK 78%, KA 71%). Whereas myocardial infarction accounted for a similar proportion of deaths in both groups, sepsis and surgical complications were more common causes of death in the SPK group. The majority of cardiovascular deaths occurred early in the SPK group compared to the KA group. Kidney graft survival was similar at 1 year (SPK 79%, KA 81%) and 5 years (SPK 66%, KA 59%). Pancreas graft survival at 1 and 5 years was 75% and 60% respectively. Biopsy-proven acute rejection occurred more frequently in the SPK group (SPK 63%, KA 46%). Morbidity was greater in the SPK group and included vascular (SPK 19%, KA 3%), non-infectious urologic (SPK 23%, KA 3%) and infectious complications (SPK 86%, KA 33%). The majority of complications in the SPK group were related to the pancreas allograft. In summary, SPK transplants were associated with an increased risk of early cardiovascular death, greater morbidity and more frequent biopsy-proven acute rejection episodes. However, kidney graft survival was not affected by the addition of the pancreas allograft.

Adult↗
PubMed1993

The effect of transfusions on renal allograft survival in the cyclosporine era: a single center report.

The potential efficacy of prior transplant transfusions on graft survival in the cyclosporine era has been reported from several centers which are reconsidering their transfusion policy. The purpose of this study has been to evaluate the results obtained in a large series of first kidney transplant patients (N=284) treated with cyclosporine. Our past experience showed a beneficial effect of blood transfusions in cadaveric renal transplants on conventional immunosuppression. Forty-eight patients never received blood transfusions, 85 patients received 1-2 transfusions, 72 patients received 3-5 transfusions and 79 patients received more than 5 transfusions in their pre-transplant periods. We did not show an obvious beneficial effect of prior blood transfusions in improving 1- and 2-year patient and graft survival. In fact, no statistically significant differences were found among any of the groups depending upon the transfusion status. In the transfused group, graft survival rates were 81.4% (1 year) and 77.8% (2 years) while in the non-transfused group they were 81.2% (1 year) and 78.4% (2 years)(p=n.s.). The patients who rejected had a significantly lower graft survival in the transfused group as compared to the non-transfused group. On the other hand, the transfused patients without rejection episodes experienced the best graft survival, suggesting a beneficial transfusion effect. We conclude that since it is impossible to determine which patients will not reject, pre-transplant transfusions under certain circumstances might be harmful, or at least not beneficial. We would recommend restricting transfusions in cyclosporine-tested patients only in cases of therapeutic necessity.

Adolescent↗
PubMed1993

Incidence, management and significance of surgical complications after pancreatic transplantation.

Despite recent advances, pancreatic transplantation is still in evolution and is associated with considerable surgical morbidity. We reviewed the surgical complications of 127 consecutive whole pancreatic transplants performed at the University of Iowa between March 1984 and January 1992, to evaluate the impact of these complications on graft and patient outcome. Of these transplantations, 89 were simultaneous pancreatic and renal transplants, 32 pancreas after kidney and six pancreas alone. Of all complications requiring hospital admission, 29 percent were surgical in nature. Graft thrombosis (19 percent), deep wound infection (18 percent), duodenal leak (7 percent) and iliac artery disruption (3 percent) were all associated with significant graft (n = 28) and patient (n = 6) loss. In contrast, recurrent urinary tract infections (20 percent), recurrent pancreatitis (17 percent), superficial wound infections (13 percent) and recurrent hematuria (12 percent) did not affect patient or graft outcome. Surgical complications after technically successful transplants were associated with a 4.9 percent mortality rate and a 4.9 percent graft loss. The overall one year actuarial patient and pancreas graft survival rate was 86 and 75 percent, respectively. Despite ongoing refinements in surgical technique, pancreatic transplantation is still associated with considerable surgical morbidity. However, the outcome is favorable if these complications are managed aggressively.

Abscess↗
PubMed1991

Pancreas transplantation: assessing secondary complications and life quality.

Two sequential studies of life quality among pancreas transplant recipients are reported. The first study (n = 32) investigated symptoms of neuropathy, enteropathy and retinopathy, along with well-being post successful transplantation. Patients noted improvement in secondary complications, were satisfied with the procedure and expressed hope for the future. The second study compared physical and social function, burden of symptoms, emotional/mental state and sense of well-being in successful (n = 31) and successful (n = 13) pancreas transplant recipients. Patient satisfaction with pancreas transplantation was high. Successful transplant patients perceived their health to be good, believed it would continue to be good, with life quality becoming better over time. The failed group expected life quality to become worse.

Depression↗
PubMed1991

The hemodynamic effects of Cremophor-EL.

A problem associated with parenteral cyclosporine has been the increased incidence of renal toxicity. Cremophor-EL, the vehicle for parenteral cyclosporine has been associated with massive histamine release and anaphylaxis in certain animal models. We investigated the effects of Cremophor-EL on the cardiac output (CO); mean arterial pressure (MAP); and hepatic, renal and pancreatic blood flow in the anesthesized canine model. Doppler flow probes were utilized to calculate individual organ blood flow. Profound adverse affects were noted on the CO, MAP, and hepatic blood flow. There were negative trends noted in the renal and splenic arterial flow that did not reach statistical significance. It was noted that the changes in organ blood flow were partially independent on MAP and the total dose of Cremophor-EL. We therefore conclude that it is prudent to consider the possible adverse hemodynamic role of Cremophor-EL in canine allograft dysfunction.

Animals↗