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Biomedical subjects

R Y Calne

Publications and source records attributed to R Y Calne.

At least 199 records · Page 11Linked to original sources
PubMed1986

Injuries to the liver.

A policy of management of liver trauma that has evolved over 15 years following experience of treating 33 cases of severe liver trauma is presented. Many patients with grave liver damage survived even in the presence of other injuries, often multiple, involving the spleen and vital organs.

Adult↗
PubMed1985

Current results with orthotopic liver grafting in Cambridge/King's College Hospital series.

In the 12 months from 1 August 1983 to 31 July 1984, 29 orthotopic liver transplant operations were performed in 26 patients, 10 of whom were aged 20 or under. Results in this younger age group were very satisfactory, nine of the patients being alive at review, giving an actuarial predicted one year survival of 75%. In the older age group seven of the 16 patients were alive, perioperative bleeding and infection in association with malnutrition being major factors in the nine who died. Two patients in whom a blocked portal vein required disobliteration at the time of the operation made excellent recoveries. An increase in availability of donor organs made possible a greater use of retransplantation, and for the first time transplantation for severe liver failure due to subacute hepatic necrosis was successful.

Adolescent↗
PubMed1985

Delayed acute rejection episodes in cyclosporine-treated renal transplant recipients.

Of 109 cyclosporine-treated cadaveric renal allograft recipients, 45 were free of acute rejection in the first 4 weeks after transplantation. Eleven of 45 (24%) subsequently had delayed, biopsy-proven first rejection episodes 34-61 days after grafting, often after discharge from the hospital. Delayed rejectors had significantly higher plasma creatinine levels at all times during the first posttransplant month than 34 nonrejectors. Trough serum cyclosporine levels were similar in the two groups, although by the 4th week oral cyclosporine dose was significantly lower in the delayed rejection group. Two-thirds of those patients who had serum creatinine levels greater than or equal to 260 mumol/l at 2 weeks and greater than or equal to 225 mumol/l at 3 weeks had a delayed acute rejection episode. Renal transplant recipients treated with cyclosporine who have serum creatinine levels at or above these levels should be aggressively worked up and closely followed for the development of delayed acute rejection.

Cyclosporins↗
PubMed1985

Oral cholecystography after liver transplantation in man.

Orthotopic liver transplantation has been performed in Cambridge since 1967. In order to prevent complications resulting from the biliary drainage techniques, the donor gall bladder was interposed between the donor and recipient common bile duct as a vascularised pedical graft. The procedure, first performed in 1976, has been employed where possible ever since. Six patients having had this technique performed, and who remained well six months to six years after liver graft, underwent oral cholecystography. Four patients opacified the interposed gall bladder and the gall bladder contracted in response to cholecystography or a fatty meal. This is the first time oral cholecystography has been used in these patients. The detail is such that it can be used to follow non-jaundiced liver-grafted patients.

Cholecystography↗
PubMed1985

Primary hyperoxaluria (type I): attempted treatment by combined hepatic and renal transplantation.

A case is reported of a patient with renal failure and developing systemic and renal oxalosis due to pyridoxine-resistant type I primary hyperoxaluria. In spite of vigorous haemodialysis and hydration before and after operation, an allografted cadaveric kidney failed because of oxalate deposits in the transplant. The patient was treated by combined hepatic and renal transplantation. The liver allograft functioned well but the kidney had poor function due to primary acute tubular necrosis aggravated by steroid-associated acute pancreatitis, systemic cytomegalovirus infection and high cyclosporin A levels. The patient died from generalised cytomegalovirus infection. The early course after operation was associated with a reduced rate of oxalate production, which would slow the rate of oxalate deposition in the tissues. The size of the oxalate metabolic pool was also diminished. These observations are compatible with the grafted liver having corrected the metabolic lesion.

Child↗
PubMed1985

Long-term use of cyclosporin in liver grafting.

The clinical course of 29 liver graft recipients in the Cambridge/King's College Hospital series who have received cyclosporin A (CyA) for up to five years (median 40 months) was analysed with particular reference to the immunosuppressive effectiveness and adverse effects of the drug. Eight patients had been maintained on prednisolone and azathioprine for two to six years before treatment was changed to cyclosporin A and the remainder were started on cyclosporin A after operation. Results in both groups over a one to five year study period are similar, and showed that cyclosporin A was effective in maintaining adequate immunosuppression, allowing complete withdrawal of prednisolone in 16 patients. Episodes of rejection were observed in only three patients and in two of these it was of the chronic 'vanishing bile duct' variety. Some evidence of nephrotoxicity (serum creatinine greater than 150 mumol/l) occurred in 72 per cent (21 of 29 patients) but it was necessary to discontinue treatment in only two. Hypertension, occasionally of sudden onset, was found in nine patients and led to the withdrawal of the drug in two. Additional hypotensive drug treatment was required in five. In one other patient cyclosporin A was discontinued on account of severe headaches. Cyclosporin A was withdrawn in two further patients. Withdrawal led to considerable risk of acute rejection and increased doses of corticosteroids as well as substitution of azathioprine were required at that time.

Adolescent↗
PubMed1984

Cyclosporine: five years' experience in cadaveric renal transplantation.

Using a retrospective analysis we compared 79 recipients of cadaveric renal allografts who were treated with cyclosporine as the sole initial immunosuppressant and 29 concurrent transplant recipients treated with conventional immunosuppressants. The cyclosporine-treated group had a slightly higher actuarial patient survival at four years (86 per cent v. 76 per cent). Actuarial graft survival at four years was 70 per cent in the cyclosporine group, as compared with 62 per cent in the conventionally immunosuppressed group. The incidence of acute rejection episodes was 62.1 per cent in the former and 65.5 per cent in the latter. Nephrotoxicity was managed either by reduction of the dose of cyclosporine or by conversion to conventional immunosuppression. Monitoring of trough serum levels of cyclosporine facilitated its administration. Serum creatinine levels have been higher in cyclosporine-treated patients with functioning grafts, but graft deterioration has not occurred after more than three years. Cyclosporine provides adequate immunosuppression for patients with renal allografts. At four years, the rates of patient and graft survival remain superior to those with conventional immunosuppression. In 41 per cent of patients the use of steroids was completely avoided. The longer-term results of this powerful immunosuppressive agent are not yet known.

Adolescent↗
PubMed1984

Organ transplantation with special emphasis on Cyclosporin A.

The history of organ transplantation and the development of immunosuppression therapy were discussed in detail, starting from Medawar's acquired immunological tolerance theory. The current status of transplantation of organs including the kidney, heart, liver and pancreas was reviewed. Current concepts of immunosuppression were discussed, with special emphasis on the use of Cyclosporin A.

Animals↗