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Biomedical subjects

R Y Calne

Publications and source records attributed to R Y Calne.

At least 55 records · Page 3Linked to original sources
PubMed1995

Liver transplantation in patients with situs inversus.

Seven patients with situs inversus abdominis and one with situs inversus totalis underwent liver transplantation; all are alive at follow-up of between 7 months and 5 years. Two patients required retransplantation within the first 3 weeks (for primary non-function and thrombotic infarction). Seven had additional abnormalities associated with the polysplenia-biliary atresia syndrome. Liver transplantation in these patients involved selection of relatively small donor organs or use of reduced-size grafts. Delayed abdominal wall closure was necessary in two patients and all required a modification of the 'piggy-back' technique of suprahepatic vena caval anastomosis to overcome recipient venous anomalies. Biliary drainage by Roux-en-Y choledochojejunostomy was the preferred technique. Although technically challenging, situs inversus is not a contraindication to liver transplantation and patients should expect full recovery.

Anastomosis, Roux-en-Y↗
PubMed1995

Effective administration of heparin and antibiotic prophylaxis.

A prospective audit was performed to determine whether new departmental procedures had improved the administration of heparin and antibiotic prophylaxis in patients undergoing major surgery who were at risk of deep vein thrombosis, pulmonary embolism and postoperative wound infection. The results are compared with a previous retrospective audit of the same 'at-risk' groups. A significant improvement in prophylaxis administration is demonstrated.

Adult↗
PubMed1995

An opportunity in organ transplantation.

Further progress in organ transplantation must overcome two key problems: a shortage of organs and long term immunological tolerance. Xenografts and immunological conditioning may help.

Forecasting↗
PubMed1995

The essential roles of parenchymal tissues and passenger leukocytes in the tolerance induced by liver grafting in rats.

Liver allografts in pigs and rodents are uniquely capable of inducing tolerance to themselves and to other grafts of donor tissues, instead of succumbing to the acute rejection that follows transplantation of other allogeneic tissues. We demonstrate here, using normal and chimaeric rat liver grafts, that both the allogeneic liver parenchyma and the intrahepatic leukocytes of donor type contribute to the establishment of long-term tolerance, each component being essential and complementary. The essential role of hepatic parenchyma may be related to its continuous release of soluble transplantation antigens that facilitate tolerogenesis. We suggest that clinical attempts at tolerance induction by the infusion of donor bone marrow-derived leukocytes may likewise be facilitated by the coadministration of soluble transplantation antigens of donor type.

Animals↗
PubMed1994

Tolerance of porcine renal allografts induced by donor spleen cells and seven days' treatment with cyclosporine.

Liver allografts in pigs and in rats elicit a substantial cellular immune response that can resolve spontaneously with the induction of donor-specific systemic tolerance. Self-limiting interactions between host and donor (graft)-derived leukocytes may be the basis for tolerogenesis. We have attempted to reproduce this effect of liver grafting in pigs by peroperative infusion of donor leukocytes into kidney graft recipients given an interrupted short course of CsA designed to promote donor leukocyte survival and interaction with host cells. This protocol can secure long-term kidney graft survival resistant to challenge by donor skin grafting. Donor skin is, however, rejected, but more slowly than third-party skin, indicating a degree of systemic specific unresponsiveness in these long-term kidney graft recipients.

Animals↗
PubMed1994

Predictive value of von Willebrand factor to ristocetin cofactor ratio and thrombin-antithrombin complex levels for hepatic vessel thrombosis and graft rejection after liver transplantation.

Acute cellular rejection and hepatic vessel thrombosis are significant postoperative complications of liver transplantation. The study investigated changes in endothelial cell-related hemostatic proteins in the peripheral circulation of patients after liver transplantation, and assays for hemostatic parameters were compared with data from routine hematologic and biochemical investigations, together with clinical information. Of the 12 patients, 8 underwent acute rejection episodes. No significant differences in any hemostatic parameter measured were seen between rejection and nonrejection groups, with the exception of the platelet count, which increased after treatment of the rejection episode. Two of the 12 patients suffered fatal hepatic vessel thrombosis during the study. A number of significant differences were found between these patients and those with no thrombotic complications, most notably and increase in the von Willebrand factor antigen to ristocetin cofactor ratio and thrombin-antithrombin complex generation. These changes occurred before clinical detection of thrombosis. Thus, measurement of these parameters may be of predictive value in the diagnosis and monitoring of post-transplant thrombosis.

Adult↗
PubMed1994

Administration of heparin and antibiotic prophylaxis.

An audit was performed to examine the time of administration of heparin and antibiotic prophylaxis to patients at risk of deep vein thrombosis, pulmonary embolism and post-operative wound infection. The records of 648 consecutive patients undergoing major surgery within a 12-month period were reviewed retrospectively. Heparin prophylaxis was given before surgery to only 30.9 per cent of patients undergoing elective procedures and in only 22.7 per cent of emergencies. Antibiotic prophylaxis was given before operation or at induction of anaesthesia to 82.1 per cent of patients undergoing elective procedures and in only 72.1 per cent of emergencies. It is concluded that administration of heparin and antibiotic prophylaxis is inadequate despite the provision of a written protocol.

Adult↗
PubMed1994

Laser-Doppler flowmetry in the study of in vivo liver ischemia and reperfusion in the rat.

Estimation of blood flow in the microcirculation is essential in the analysis of the events that occur during organ ischemia and subsequent reperfusion. In this study the use of laser-Doppler flowmetry is evaluated as a method for studying liver blood flow in the rat using an in vivo ischemia-reperfusion model. The experimental procedure consists of the temporary interruption of blood flow to the left lateral and medial lobes of the liver and subsequent recording of the postischemic liver blood flow using a laser-Doppler flowmeter. Flow was recorded for 60 min after periods of ischemia of 30 sec (control), 30, 45, and 60 min. The reperfusion records showed a biphasic curve with a mean flow of 59.6% of the baseline after 30 min of ischemia and of 38.3 and 41.1% after 45 and 60 min of ischemia, respectively. There were statistically significant differences between all the groups and the controls, and between 45 and 30 min of ischemia but not between 45 and 60 min. This is a useful model for studying ischemic liver injury in the rat.

Analysis of Variance↗
PubMed1994

Biliary tract reconstruction: comparison of different techniques after 187 paediatric liver transplantations.

Biliary complications after liver transplantation are common and cause significant morbidity and mortality. In order to evaluate the complications related to different sorts of biliary reconstruction, from January 1984 to July 1992 we retrospectively analysed 187 consecutive liver transplants in 136 paediatric patients at Addenbrooke's Hospital, Cambridge. There were 51 (27.2%) retransplantations. Biliary reconstruction consisted of: type 1-common bile duct-Roux loop (CBD-RL); n = 90 (48.1%); type 2-gallbladder conduit-Roux loop (GC-RL), n = 51 (27.2%); type 3-gallbladder conduit-common bile duct (GC-CBD), n = 20 (10.6%); type 4-common bile duct-common bile duct (CBD-CBD), n = 18 (9.6%); and type 5-common bile duct-common bile duct+gallbladder drainage (CBD-CBD+GB), n = 8 (4.2%). There were, in all 26 biliary complications (14%). Of these 26 complications, biliary stricture was the most common (17/26; 65.3%) and 6 out of these 17 (35.2%) were associated with chronic rejection. Hepatic artery thrombosis was directly related to biliary leakage in 6 out of 26 (23.1%) biliary tract complications. This series demonstrated that type 1 and type 4 reconstructions were related to fewer biliary complications (9/90, 10% and 2/18; 11%, respectively) than the other techniques: 8/51 (16%) for GC-RL 5/20 (25%) for GC-CBD and 2/8 (25%) for CBD-CBD+GB (P = 0.09).

Adolescent↗