Successful pancreas transplantation can result in the longterm normalization of glucose metabolism. Since most pancreas recipients already have severe diabetic complications, and the observation period after transplantation is rather short, an assessment of the effect of complete glucose normalization on these diabetic changes is problematic. It has, however, been shown that the development of diabetic nephropathy can be prevented, peripheral microcirculation improved, and autonomic and peripheral neuropathy and retinopathy stabilized. These positive effects are, possibly, in part due to the elimination of uremia, since most patients receive both a pancreas and a kidney. The aim must be to perform pancreas transplantation in an early stage of diabetes, even though remarkable improvements have also been reported in terminal stages of the disease, and the quality of life of these patients has been significantly improved.

Blood Glucose↗

PubMed1990

[Repeated kidney transplantation. Surgical technic, results and complications].

Third renal transplants were performed in 31 patients (25 men and 3 women: mean age 33 +/- 11 years) with terminal renal failure. Surgical complications occurred in four of them. Acute rejection crises were frequent (48%). In three cases acute humoral vascular rejection led to loss of the grafted kidney. One patient died within 3 months. The proportion of functioning transplants was 83% at 3 months, 59% at 1 year and 20% at 5 years. Such factors as the concentration of panel-reactive antibodies, a history of previous acute humoral rejection crises or the timing of the previous transplant loss had no influence on the prognosis of the new graft. After a mean observation period of 35, 4 months patients whose HLA-DR antigens matched those of the donor at one or two loci had a markedly higher proportion of functioning renal transplants (69% and 64%, resp.) than patients without HLA-DR compatibility (0%; P less than 0.01). These results indicate that a third renal transplant does not carry any increased perioperative risk, and that the proportion of functioning transplants is good in the short term, though the long-term results are poor. Prolonged survival of the renal transplant can be expected only if there is an optimal HLA-DR match between donor and recipient.

Adult↗

PubMed1990

[Infections following kidney transplantation under threefold or fourfold immunosuppressive treatment].

To determine, whether the infection rate after renal transplantation is influenced by the intensity of immunosuppressive treatment, the postoperative course of 100 consecutive renal transplantations in 64 men and 36 women (mean age 44.1 [18-72] years) was investigated prospectively. 87 patients received threefold basal immunosuppression with low-dose ciclosporin, azathioprine and prednisolone. In 13 risk patients (retransplantation and [or] high panel-reactive antibody titres), poly- or monoclonal antibodies were administered additionally to prevent rejection. Steroid-resistant rejection crises had to be treated with poly- or monoclonal antibodies in 15 patients. Postoperatively there were 10 patients with systemic infections (5 with cytomegalovirus, 4 with herpes simplex virus and 1 with Pneumocystis carinii). The infection rate with three- or fourfold immunosuppression did not differ significantly (5.4% vs. 9.1%). However, infections occurred more frequently after additional antirejection treatment with poly- or monoclonal antibodies (33%). It is concluded from these results that fourfold basal immunosuppression treatment with poly- or monoclonal antibodies is not associated with an increased risk of perioperative infections.

Adolescent↗

PubMed1990

[Indications for pancreas transplantation].

Explore the source record for details and available documents.

Diabetes Mellitus, Type 1↗

PubMed1990

Organ donation: the role of hospitals.

Three models of cooperation between hospitals and transplant centres are: (1) performance of brain death diagnosis, organ removal and preservation at the peripheral hospital; (2) performance of brain death diagnosis at the peripheral hospital and transportation of the dead body under ICU modalities to the transplant centre; (3) transport of a potential organ donor to the transplant centre. The key issues for success in cooperation between peripheral hospitals and transplant centres are: positive attitudes of hospital representatives; motivation and acceptance of ICU staff, supported by the whole community; and availability of adequate facilities to perform organ recovery in practice.

Attitude of Health Personnel↗

PubMed1990

Transthoracic high frequency (7.5 MHz) echocardiographic assessment of coronary vascular reserve and its relation to left ventricular mass.

Transthoracic high frequency (7.5 MHz) ultrasonography can visualize the distal left anterior descending coronary artery. Thirty-seven patients were studied before and after administration of 0.4 mg sublingual nitroglycerin to determine whether this technique could quantitatively record changes in coronary artery diameter after intervention. Left anterior descending coronary artery diameter increased from 2.2 to 2.8 mm (p less than 0.05). The vasodilator response of this artery was compared with left ventricular mass index in normal subjects, patients with congestive cardiomyopathy and those with end-stage renal disease and left ventricular hypertrophy. Left anterior descending artery diameter increased 55% in normal subjects, 27% in patients with dilated cardiomyopathy and 10% in those with end-stage renal disease with left ventricular hypertrophy. These results demonstrate that high frequency ultrasound can detect nitroglycerin-induced changes in left anterior descending artery diameter. The percent increase is related to the diameter before nitroglycerin administration, which is related to the underlying diagnosis and left ventricular mass index.

Adult↗

PubMed1990