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Biomedical subjects

W T Stubenbord

Publications and source records attributed to W T Stubenbord.

60 records · Page 4Linked to original sources
PubMedDate not supplied

Infection following renal transplantation: a changing pattern.

The spectrum of infectious complications during the first six months after 101 consecutive renal transplants was examined. The most common sites of infection were the lungs, the urinary tract, and the surgical incision. The causative organisms were similar to those in nonimmunosuppressed postsurgical patients. The infections were usually recognized readily by routine clinical examination and responded promptly to antibacterial therapy. Three patients developed opportunistic infection. No patient died as a result of infection. As at several other institutions in recent years, a declining frequency of serious or opportunistic infection in these immunosuppressed patients was noted. However, the results of this study differed markedly from recently reported data which emphasize the importance of overt cytomegaloviral disease as a cause of morbidity and as a factor predisposing to serious--often fatal--superinfection. These differences may be related to the immunosuppressive agents used and certainly have important implications for diagnostic and therapeutic management.

Adolescent↗
PubMedDate not supplied

Prostaglandin E1 improves pulsatile preservation characteristics and early graft function in expanded criteria donor kidneys.

Unlike simple cold storage, machine preservation allows dynamic assessment and manipulation of the donor organ before transplantation. The effects of four pharmacologic agents added to the perfusate during machine preservation of expanded criteria donor (ECD) kidneys were prospectively compared to 1) describe their influence on perfusion parameters and 2) determine their influence on early graft outcome. Between 1 January 1995 and 1 October 1997, 125 consecutive ECD kidneys were preserved in the authors' laboratory. A definition of ECD was assigned to kidneys requiring pretransplant biopsy. The ECD kidneys were randomized to receive prostaglandin E1 (PGE1), trifluoperazine (TFP), verapamil (VER), mannitol (MAN), or no intervention (control) during machine preservation. All kidneys were preserved by continuous hypothermic pulsatile perfusion (CHPP) using Belzer II solution, and perfusion parameters were measured every 2 hours during pulsatile perfusion. The addition of PGE1 to the perfusate increased renal flow and decreased renal resistance. Moreover, the PGE1 treated group was associated with improved early graft function when compared with all other groups. The addition of VER, TFP, and MAN influenced neither the perfusion characteristics nor the incidence of early graft function. Treatment with PGE1 during machine preservation enhances hydrostatic perfusion parameters (renal flow and renal resistance) and reduces the incidence of delayed graft function in ECD kidneys.

Alprostadil↗
PubMedDate not supplied

Induction of donor-specific immune modulation and successful renal transplantation with a simplified method of donor-specific blood transfusion.

We developed a new method of donor-specific blood transfusion (DST) for prospective kidney transplant recipients from a living related donor. Forty-four patients were transfused with 100 ml of one-haplotype matched kidney donor's whole blood at 1, 8, and 15 days after its storage. Ten of these patients received azathioprine (1.5 mg/kg per day) in addition to DST. After DST, three patients (6.8%) developed donor-specific lymphocytotoxic antibodies. The incidence of sensitization was not different between azathioprine-treated and untreated patients. Following DST, donor-specific mixed lymphocyte culture (MLC) was significantly suppressed without any accelerated (secondary type) response in early MLC. Subsequently, 24 patients received a kidney transplant from the donor. Graft survival rates were 96% and 90% at 12 and 24 months, respectively. Nine additional patients, seven from a two-haplotype matched sibling and two from a no-haplotype matched sibling also received DST. None of these patients became sensitized following DST, and all have functioning grafts for 6 to 18 months. This study indicates that 100 ml of stored whole blood DST three times at weekly intervals is a practical, less immunizing, and effective approach to enhance graft survival in recipients of a living related donor graft, DST produces donor-specific adaptive responses that might be conductive to successful graft outcome, and this protocol could be used in sibling donor-recipient pairs who do not share a haplotype.

Adult↗