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Biomedical subjects

R Y Calne

Publications and source records attributed to R Y Calne.

At least 127 records · Page 7Linked to original sources
PubMed1990

Biliary complications following orthotopic liver transplantation.

The gall-bladder conduit anastomosis (choledocho-cholecysto-choledochostomy) has been the most frequently used technique for the biliary tract anastomosis in the Cambridge/King's College Hospital joint liver transplantation programme since 1976. Cholangiograms and interventional biliary procedures performed over a 3 year period were reviewed retrospectively. Seventy-six of 148 patients managed post-operatively at King's College Hospital were studied (79 transplants). Cholangiograms were abnormal in 63 (80%) transplants with biliary strictures; inspissated bile formation, bile leak and T-tube malposition occurring in 50, 23, 14 and three transplants respectively. Anastomotic strictures occurred most frequently, predominantly at the proximal anastomosis, and the presence of inspissated bile and the T-tube in relation to these contributed towards subsequent biliary obstruction. Non-anastomotic strictures in the donor biliary tract were associated with a high position of the T-tube tip at or above the liver hilum. Saline irrigation of the bile ducts for inspissated bile or its removal via the endoscope were effective measures in the management of biliary obstruction but percutaneous balloon dilatation and endoscopic stent insertion for biliary strictures were found to have a limited role.

Adolescent↗
PubMed1990

Viral and toxoplasma gondii infections in children after liver transplantation.

The incidence and morbidity of viral and Toxoplasma gondii infections were studied in 40 children who underwent liver transplantation between December 1983 and February 1988. The incidence of primary and reactivated cytomegalovirus (CMV) infection was 19% and 47%, respectively; primary infection caused clinical disease in all five cases affected and was fatal in one. Primary Epstein-Barr virus (EBV) infection occurred in 10 (26%) recipients but caused only mild disease. No reactivated EBV infection was recorded and no lymphoproliferative disorders associated with EBV were found after a maximum of four years' follow up. Adenovirus infection occurred in seven (18%) patients; this was associated in one case with fatal pneumonia and fulminant hepatitis, but otherwise with only mild respiratory disease. Primary T gondii infection was detected in one patient who remained asymptomatic. Other viruses causing infection included herpes simplex, varicella zoster, and respiratory syncytial virus. Surveillance for these infections and the long term sequelae should be included in the follow up of all children who undergo transplantation.

Adenovirus Infections, Human↗
PubMed1990

Hypertensive exercise responses in ciclosporin-treated normotensive renal transplant recipients.

Although many patients taking ciclosporin (CS) for the long term develop hypertensive side effects, a proportion do not. We have studied the blood pressure response to graded upright bicycle exercise while continuously recording the metabolic rate in 18 normotensive renal transplant recipients whose mean age was 30.8 years (range 16-54). Nine were treated with CS alone and 9 with azathioprine and a steroid, prednisolone (AzS). Both groups performed a progressive exercise test, with work increasing by 25 W every 4 min from rest. All patients completed a workload of at least 75 W during the test. A group of 8 normal subjects whose mean age was 29 years (range 19-44) were exercised with the same protocol. The CS group had a significantly higher mean systemic blood pressure at both 50 and 75 W (124 and 132 mm Hg, respectively), compared with the AzS group (103 and 108 mm Hg; p less than 0.01). The blood pressure response to exercise in the AzS group was similar to that observed in the normal group. This was despite a higher metabolic rate at each stage of work in the AzS group as compared with the CS or normal groups. Despite being normotensive at rest, renal transplant patients who are treated with CS have evidence of a vasopressor effect, with systemic vascular resistance inappropriately high for exercise, implying reduced compliance of the vascular bed.

Adolescent↗
PubMed1989

Liver transplantation for primary and secondary hepatic apudomas.

Four patients underwent liver transplantation in the Cambridge/King's College Hospital programme for malignant primary and secondary apudomas, secreting various peptide hormones and uncontrollable by standard treatment techniques. After transplantation all patients had excellent symptomatic relief and specific peptide hormone levels fell to normal ranges. Two patients remain alive and well after 38 and 22 months, the latter with recurrence of slight tumour-related symptoms and elevation of the specific secretory product. The other two patients died from chronic graft rejection 7 and 8 months after transplantation.

Adult↗
PubMed1989

Evidence for disease recurrence after liver transplantation for primary biliary cirrhosis. Clinical and histologic follow-up studies.

Twenty three patients with primary biliary cirrhosis surviving for greater than 1 yr after liver transplantation were studied. All reported marked symptomatic improvement, and had significant falls in serum bilirubin, alkaline phosphatase (p less than 0.0001), immunoglobulin M, and antimitochondrial antibody levels (p less than 0.005). Beyond 1 yr, liver biopsies showed features compatible with disease recurrence in 9 of 10 patients, and a further 4 patients developed pruritus or associated abnormalities. Immunoglobulin M levels were raised in 80%, with elevated antimitochondrial antibody titers in all those tested. Cyclosporine treatment in some patients initially given prednisone and azathioprine was followed by regression of histologic abnormalities. Of 102 patients with nonprimary biliary cirrhosis followed similarly, 50 underwent biopsy, and although 12 showed features of bile duct damage, all had additional histologic and clinical changes supporting an alternative diagnosis. These findings are consistent with previous reports that primary biliary cirrhosis can recur after transplantation, possibly modified by the use of cyclosporine.

Autoantibodies↗
PubMed1989

Orthotopic transplantation of the liver in children with biliary atresia and polysplenia syndrome: report of two cases.

Biliary atresia is the most common indication for liver transplantation in infants and children, despite the advent of the Kasai operation. Coexisting anomalies, which have been noted in up to 27% of patients with biliary atresia, may form an association known as the "polysplenia syndrome," which includes (1) polysplenia, (2) midgut malrotation, (3) preduodenal portal vein, (4) absent prerenal inferior vena cava with azygos continuation, (5) situs inversus, (6) symmetric liver, (7) hepatic arterial anomalies, and (8) bilobed right lung with hyparterial bronchus. Two of 31 patients undergoing orthotopic liver transplantation for biliary atresia following failed portoenterostomy over the past 11 years manifested the polysplenia syndrome with absent prerenal inferior vena cava. The clinical course of these patients, constellation of anomalies, and technical adjustments required to perform liver transplantation are described. We do not believe that these complex congenital anomalies preclude liver transplantation.

Abnormalities, Multiple↗
PubMed1989

Soluble HLA antigens in the circulation of liver graft recipients.

Human liver allografts deliver soluble class I (HLA-A and -B) transplantation antigens into the recipients' circulation. These molecules are detectable in recipient serum shortly after transplantation and they persist at high concentration for as long as the liver graft functions. Levels of graft-derived antigens in the recipient serum and self antigens in donor serum are comparable. Kinetic studies of these soluble antigens in donor and recipient show that donor antigens are continuously exported by the transplanted liver, while in the recipient, self antigens are derived from liver and other sources. At least two molecular forms of soluble HLA-A and -B antigens are present in sera from donors, recipients, and normal individuals. One form with m.w. approximately 50 kd seems to be a soluble monomer associated with beta 2-microglobulin, while the other forms of higher m.w. may be aggregates and/or complexes. Monitoring of these antigens in transplant recipients may be a useful indicator of graft pathology and function.

HLA-A Antigens↗
PubMed1989

Campath-1M--prophylactic use after kidney transplantation. A randomized controlled clinical trial.

Campath-1M is a rat monoclonal IgM antibody that binds human complement and recognizes virtually all peripheral human mononuclear cells. It is known to be effective in T cell depletion of bone marrow grafts, and encouraging results were obtained in a pilot study in which the antibody was used in prevention and treatment of rejection of kidney, pancreas, and liver allografts. In this randomized controlled clinical trial, Campath-1M has been evaluated as a prophylactic agent following renal allografting. It is shown that patients who received a 10-day course of the antibody immediately postoperatively, in addition to standard therapy with high-dose cyclosporine (17 mg/kg), experienced a significantly lower incidence of early acute cellular rejection than control patients who received cyclosporine alone. There was no evidence of "rebound" rejection following the end of antibody treatment to suggest that rejection had merely been delayed. However, patients who received this additional immunosuppression experienced a significantly higher incidence of serious infections than controls, this negating any benefit from the treatment in terms of graft survival. Thus, a monoclonal antibody of broad specificity directed against lymphocytes may be effective as a prophylactic agent after organ transplantation but its use should be accompanied by a reduction in other immunosuppressive drugs.

Antibodies, Monoclonal↗