A prospective randomized double-blind controlled study of cadaver donor pretreatment with cyclophosphamide in human renal transplantation.
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Cyclophosphamide↗
Biomedical subjects
R N Fine
Publications and source records attributed to R N Fine.
Hepatitis B infection in pediatric dialysis and transplant patients: significance of e antigen.
We examined the clinical significance of hepatitis Be antigenemia in 36 HBsAg positive pediatric dialysis and renal transplant patients. One hundred twenty-seven sera were tested for HBeAg and anti-HBe. Seventy-three sera (57%) from 29 patients (81%) contained HBeAg. The presence of HBeAg was associated with an increased titer of HBsAg (P < 0.005) and with the presence of the HBsAg carrier state (P < 0.001). HBeAg was found in 40% of specimens taken from dialysis patients, and in 70% of specimens from transplant patients (P < 0.001). No serum contained anti-HBe, although 28 of 29 sera (97%) tested had antibody to HBcAg. No association was found between the presence of HBeAg and serum aminoleucine transferase levels or the histologic evidence of chronic active hepatitis. Fifteen HBeAg negative sera from patients persistently positive for HBsAg were tested for HBV-specific DNA polymerase activity; 7 (47%) had significant activity. Since both HBeAg and DNA p are indicators of infectivity, many HBeAg negative sera from immunosuppressed HBsAg carriers may be infectious.
Adolescent↗
Renal transplantation in children with obstructive uropathy.
The outcome of renal transplantation was examined in 52 pediatric patients (mean age 13 years) whose primary renal disease was obstructive uropathy. The bladder was used at transplantation in 45 allograft recipients, 39 of whom had had a previous lower urinary tract operation or bladder defunctionalization. An ileal loop was used in 7 recipients. The 52 patients received 73 renal allografts from 58 cadaver and 15 live-related donors. Presently, 40 patients (77 per cent) have functioning allografts, 4 have returned to dialysis and 8 (15 per cent) have died. The results indicate that the outcome of renal transplantation in patients with obstructive uropathy is similar to that of other transplant recipients. Damaged and defunctionalized bladders may be used successfully in most cases. If necessary an ileal conduit is an effective alternative. Post-transplant urologic complications occur with increased frequency but with appropriate management allograft salvage and patient survival are excellent.
Adolescent↗
Accelerated acute rejection of primary renal allografts in pediatric patients.
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Antibodies↗
Renal transplantation in children less than 5 years of age.
19 young children (less than 5 years old) have received 31 renal transplants from 4 live relatives and 27 cadaver donors. The 2-year allograft survival rate for the patients receiving their 1st allograft from the 4 live donors was 75 +/- 22% while for the patients receiving their 1st allograft from 15 cadaver donors was 26 +/- 11%. 10 children are currently surviving with functioning allographs (7 cadavers and 3 live relatives); 4 have died and 5 are undergoing dialysis after the loss of at least one allograft. Despite the poor allograft survival rate the fact that 7 children are surviving with cadaver allografts indicates that the lack of a living related donor should not prevent transplants in young children.
Adolescent↗
Physical and psychological follow-up on offspring of renal allograft recipients.
In light of concern regarding the effect of pregnancy on renal allograft recipients and the lack of information about their offspring, we studied ten infants born to eight allograft recipients (five female and three male). In all five female recipients, allograft function remained normal throughout pregnancy and the puerperium. Complications of pregnancy were minimal. Four patients were delivered by cesarean section, three for obstetrical reasons and one electively. Three of ten infants were premature births. There were no significant neonatal complications. At time of follow-up study, the offspring were 4 months to 6 8/12 years of age; physical examination was normal on all offspring. Developmental test results ranged from 82 to 131. Parents tended to be overly cautious and sought medical attention at the first sign of illness. Our data indicated no adverse effect on renal allograft function of the female recipients and no physical or developmental abnormalities in the offspring.
Adult↗
Pretransplant T cell levels and renal allograft survival rates.
Total rosette forming cell (TRFC) levels were measured in 50 patients awaiting cadaveric renal transplantation. Preliminary data show a statistically significant difference in allograft survival in patients with low TRFC levels before transplant as compared with patients with medium or high TRFC levels. Pretransplant TRFC levels may be predictive of a nonresponder status and portend a favorable renal allograft outcome.
Adolescent↗
Renal retransplantation in children.
Evaluation of 75 cadaver donor retransplants revealed that the primary factor influencing allograft survival is patient responsiveness as reflected by sensitization with preformed cytotoxic antibodies. Actuarial allograft survival rates for nonpresensitized (less than 5%) and moderately presensitized (5 to 50%) recipients were significantly (P less than 0.01) better than those of highly presensitized (greater than 50%) recipients. Although HLA A&B antigen histocompatibility did not have a statistically significant effect on retransplant outcome, it appeared to influence allograft survival in the highly presensitized recipient. An approach to the management of children who lose an initial or subsequent allograft is indicated by these data.
Adolescent↗
Focal glomerulosclerosis and renal transplantation.
Eighteen patients with corticosteroid-resistant nephrotic syndrome developed end-stage renal disease and received one or more renal allografts. The lesion of focal segmental glomerulosclerosis and/or of focal glomerular obsolescence was demonstrable in the native kidneys of each patient. Following transplantation, nephrosis developed in three recipients. Two recipients developed nephrosis at two weeks and nine months posttransplant in association with rejection; the lesion of FGS was present in association with chronic rejection. Only one recipient developed recurrence of nephrosis and FGS unrelated to rejection. This was manifested by immediate onset of nephrosis in two successive allografts and histologic evidence of the lesion of FGS. The immediate recurrence in successive allografts suggests a circulating factor responsible for the renal lesion in this patient and indicates a separate etiology for a small number of patients with corticosteroid-resistant nephrosis and FGS.
Cadaver↗
Somatomedin activity and growth hormone concentration in pediatric renal allograft recipients.
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Adolescent↗
Long-term cadaver allograft survival in the recipient with a positive B lymphocyte crossmatch.
Over a 2 1/2-year period, prospective standard, T, and B lymphocyte crossmatches were performed in 45 cadaver renal transplants using the microlymphocytotoxicity technique. Twenty-three of the 45 recipients had a positive B lymphocyte crossmatch. Cumulative graft survival rates did not differ between recipients with a positive and negative B lymphocyte crossmatch. High levels of presensitization in routine lymphocytotoxic antibody screening or transplant number did not adversely affect graft survival in recipients with a positive B lymphocyte crossmatch. Five recipients had moderately positive standard crossmatches which were attributable to anti-B lymphocytotoxicity. Four of these five grafts are presently functioning with normal serum creatinine levels 9 to 14 months post-transplant. A positive B lymphocyte crossmatch is compatible with good long-term cadaveric renal allograft survival. In addition, a weakly positive standard crossmatch is not a contraindication to transplantation when the positive crossmatch is attributable to anti-B lymphocyte antibody.
Adolescent↗
Use of antithymocyte globulin (dose by rosette protocol) in pediatric renal allograft recipients.
Total rosette-forming cells (TRFCs) and percentage of rosette-forming cell (RFC) levels were measured in patients undergoing dialysis and in recipients following renal transplantation. The percentage of RFCs of the dialysis patients was not different from the percentage of RFCs of normal subjects, whereas the TRFCs were significantly lower in the dialysis patients. After transplantation, the percentage of RFCs and TRFCs was significantly lower in recipients treated with antithymocyte globulin (ATG) than in those of the control group; however, there was no difference in allograft survival between the ATG-treated and control recipients when using ATG in the dose by rosette protocol.
Adolescent↗
A beneficial effect of the in situ kidney on in vitro marrow erythropoiesis in chronic renal failure.
The effect of the in situ kidney on transfusion requirements and in vitro erythropoiesis was investigated in 20 patients with end stage renal disease undergoing hemodialysis. 6 of the 12 patients with in situ kidneys did not require transfusion, whereas the other 6 had an average monthly transfusion requirement of 277 ml of sedimented RBCs. All 8 anephric patients required transfusions with an average requirement of 352 ml of sedimented RBCs per month. Serum erythropoietin activity was inappropriately low for the degree of anemia in all but 1 patient, and bone marrow was uniformly hypocellular. Marrow cells from patients with in situ kidneys exhibited a greater response to erythropoietin than marrow cells from their anephric counterparts. The response was not improved by hemodialysis.
Bone Marrow Cells↗
Poststreptococcal acute glomerulonephritis: fact and controversy.
Poststreptococcal acute glomerulonephritis is prototypic of the immunologic glomerulonephritides. It most commonly follows streptococcal infection of the pharynx or skin. The diagnosis is usually not difficult when a nephritic clinical presentation (with such manifestations as hematuria, edema, and hypertension) is associated with serologic evidence of recent streptococcal infection and a depressed serum complement concentration. Currently, however, the nephritogenic antigen(s) has not been identified and has not been shown to be the same antigen for all nephritogenic streptococci; it may not even be a part of the infecting organism. The development of a vaccine to prevent this illness from occurring is therefore still not possible. Whether poststreptococcal acute glomerulonephritis progresses to chronic renal failure is still uncertain. Painstaking laboratory research together with careful, prospective long-term follow-up studies of patients with poststreptococcal acute glomerulonephritis may provide some of the answers to these critical questions.
Acute Disease↗
Somatomedin and growth hormone studies in pediatric renal allograft recipients who receive daily prednisone.
Plasma somatomedin (SM) activity and growth hormone (GH) concentration were measured in ten growth-retarded, well-nourished pediatric renal allograft recipients who received daily prednisone therapy. The SM activity ranged from 0.21 to 1.22 micron/mL, and it was subnormal in three patients. A significant correlation was found between SM activity and creatinine clearance. Serial SM levels were determined during a 24-hour period in five patients; SM activity decreased at six and 12 hours and returned to normal values by 24 hours. The 24-hour plasma GH concentrations ranged from 1.5 to 7.6 mg/mL. Peak GH concentrations ranged from 2.1 to 14.2 ng/mL after insulin-induced hypoglycemia and from 1.8 to 24.6 ng/mL after oral glucose loading. Sleeping GH peaks were absent in two patients. These results suggest that growth failure in renal allograft recipients who receive daily prednisone may result from (1) partial GH deficiency, (2) reduced SM levels owing to diminished allograft function, and (3) daily transient decrease in plasma SM levels after prednisone administration.
Adolescent↗
Antibodies to donor B lymphocytes and autoantibodies in renal transplantation.
A positive CDC B-lymphocyte XM is not deleterious to long-term graft outcome. A positive unfractionated CDC XM is not a contraindication to transplantation if the positive crossmatch is due entirely to anti-B-lymphocyte antibody. B-lymphocyte autoantibodies are common in hemodialysis patients, but may account for only a minority of positive B-lymphocyte XMs.
Antilymphocyte Serum↗
Long term followup of cataracts in children after renal transplantation.
In reviewing the course of 218 renal transplantation recipients 55% have developed PSC of which eleven patients have had surgery on one or both eyes; The operations in general have been uncomplicated, and the visual results have been excellent with the exception of one case that had a detached retina. The cataracts were probably induced by heavy corticosteroid therapy as the larger the dosage and the younger the recipient, the more prone were they to the development of lens changes. Phacoemulsification was preferred in this series as the more expeditious technique, leading to a clearer anterior chamber with less chance of developing a secondary cataract.
Adolescent↗
Pretransplant T cell levels and renal allograft survival.
Total rosette forming cell (TRFC) levels were measured in 50 paediatric patients awaiting cadaveric renal transplantation. Preliminary data show a statistically significant difference in allograft survival in patients with low TRFC levels pretransplant as compared with patients with medium or high TRFC levels. Pretransplant TRFC levels may be predictive of a non-responder status and portend a favourable renal allograft outcome.
Actuarial Analysis↗