Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 49
Filter
Add more filters

Country/Region as subject
Publication year range
1.
Pediatr Transplant ; 14(7): 919-24, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20840437

ABSTRACT

Low-weight pediatric recipients are disadvantaged by scarcity of size-matched donors. ASK have been successfully used for pediatric recipients. We report the results of renal transplantation using ASK in low-weight pediatric recipients and compare outcomes in weight-matched and unmatched donor-recipient pairs. The outcomes of renal transplants using ASK grafts in low-weight (<20 kg) recipients from a single center over a 10-yr period were reviewed. Two groups, comprising recipients of grafts from weight-matched and mismatched donors, were compared. Primary outcome was one-yr graft survival. Secondary outcomes were one- and two-yr calculated eGFR, changes in recipient body weight, perioperative cardiovascular stability, rates of AR and DGF. Twenty-three low-weight recipients were transplanted. Eleven received ASK grafts from high-weight donors and 12 grafts from low-weight donors. One patient in each group had early graft loss. No significant difference was observed in rates of DGF, AR, one-yr graft or patient survival and perioperative cardiovascular parameters. ASK with considerable donor:recipient weight discrepancies can be safely transplanted into small pediatric recipients with comparable outcomes to grafts with less weight discrepancy.


Subject(s)
Kidney Transplantation/methods , Organ Size , Body Weight , Child , Child, Preschool , Female , Glomerular Filtration Rate , Graft Survival , Humans , Male , Pediatrics/methods , Retrospective Studies , Risk Factors , Tissue Donors , Treatment Outcome
3.
J Clin Invest ; 82(4): 1430-6, 1988 Oct.
Article in English | MEDLINE | ID: mdl-3262628

ABSTRACT

Marrow and peripheral blood cells from nine children with juvenile chronic granulocytic leukemia (JCGL) demonstrated intense (94 +/- 16% maximum) spontaneous granulocyte/macrophage colony growth but cells from five children with the adult variety of CGL did not. This unusual pattern of colony growth depended upon a stimulatory protein(s) produced by mononuclear phagocytes. No GM-CSA activity was found in any chromatofocused fraction of JCGL monocyte-conditioned media but an activity that induced GM-CSA in umbilical vein endothelial cells was detected at pI 6.9-7.2. Moreover, the CSA-inducing monokine was neutralized by an anti-IL-1 antibody in vitro and, in the one case so tested, the same antibody also inhibited "spontaneous" colony growth. Therefore granulocyte/macrophage colony growth in JCGL is characteristically abnormal and distinguishes JCGL from the adult form of the disease. This abnormality depends upon the production, by mononuclear phagocytes, of IL-1 which, in turn, stimulates the release of high levels of colony stimulating activity by other cells. The high proliferative activity of CFU-GM we found in JCGL patients, and the high levels of GM-CSA found in their serum are compatible with the view that the in vitro abnormality reflects a similar abnormality in vivo.


Subject(s)
Granulocytes/pathology , Hematopoiesis , Interleukin-1/physiology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Adult , Bone Marrow/metabolism , Bone Marrow/pathology , Child , Colony-Forming Units Assay , Colony-Stimulating Factors/biosynthesis , Colony-Stimulating Factors/physiology , Culture Media , Hematopoiesis/drug effects , Humans , Interleukin-1/biosynthesis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/classification , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism , Macrophages/metabolism , Macrophages/pathology , Monocytes/metabolism , Monocytes/pathology
4.
Leukemia ; 6(8): 809-13, 1992 Aug.
Article in English | MEDLINE | ID: mdl-1640733

ABSTRACT

The production of colony-stimulating activity (CSA) by phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells (PBMC) from patients receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL) was examined. Supernatants from only 14 of 22 patient PBMC cultures (64%), but all supernatants from normal PBMC cultures, supported myeloid colony growth. When present, colony-stimulating activity always included granulocyte-macrophage colony-stimulating factor (GM-CSF). In addition, in nine of ten patient studies and in all control studies, stimulated PBMC produced interleukin-1 (IL-1). These results show that the chemotherapy administered to children with ALL can damage the cytokine production mechanisms in PBMC; the diminished ability to produce GM-CSF and IL-1 may contribute to the increased risk of overwhelming infection in these patients.


Subject(s)
Antineoplastic Agents/adverse effects , Granulocyte-Macrophage Colony-Stimulating Factor/biosynthesis , Interleukin-1/biosynthesis , Leukocytes, Mononuclear/drug effects , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Adolescent , Child , Child, Preschool , Female , Humans , Leukocytes, Mononuclear/metabolism , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
5.
Pediatrics ; 79(3): 399-402, 1987 Mar.
Article in English | MEDLINE | ID: mdl-3822639

ABSTRACT

Six children with lymphoreticular malignancy arising in the pharyngeal tonsils or adenoids are presented. Early clues to the possible malignant nature of the enlargement of tonsils and adenoids in this series include: asymmetric and persistent enlargement, the absence of such manifestations of infection as fever or pain, and the association of atypical adenopathy. Lack of clinical suspicion brings with it the risk of delayed diagnosis and possible compromise of optimal therapy.


Subject(s)
Adenoids , Lymphoma, Non-Hodgkin/diagnosis , Tonsillar Neoplasms/diagnosis , Adenoidectomy , Adolescent , Child , Child, Preschool , Female , Humans , Lymphoma, Non-Hodgkin/surgery , Male , Tonsillar Neoplasms/surgery , Tonsillectomy
6.
J Endocrinol ; 146(1): 131-9, 1995 Jul.
Article in English | MEDLINE | ID: mdl-7561609

ABSTRACT

We have previously shown that a bovine (b) GH antagonist, bGH-M8, which possesses three amino acid substitutions in its third alpha-helix, inhibits mouse 3T3-F442A preadipocyte differentiation. In the current studies, we used the bGH and human (h) GH analogs with single amino acid substitution, bGH-G119R and hGH-G120R, for determining their biological activity using the preadipocyte differentiation assay. Short-term and long-term GH-inducible events were studied during adipose differentiation, including late marker gene expression (adipocyte protein 2), immediate early gene induction (c-fos), and tyrosine phosphorylation of intracellular proteins. The results demonstrated that these GH analogs not only failed to induce these three events, but also antagonized GH induction of c-fos expression and phosphorylation of proteins of apparent molecular mass of 95 kDa. Our present study agrees with the notion that GH must bind to the GH receptor via site one and with a second GH receptor molecule (or with some yet unidentified 'second target') through GH binding site two. This interaction is important for subsequent GH-dependent biological events.


Subject(s)
Adipocytes/cytology , Growth Hormone/analogs & derivatives , Neoplasm Proteins , Nerve Tissue Proteins , Recombinant Proteins , Adipocytes/drug effects , Animals , Blotting, Northern , Carrier Proteins/genetics , Cell Differentiation/drug effects , Cell Line , Cells, Cultured , Fatty Acid-Binding Protein 7 , Fatty Acid-Binding Proteins , Fatty Acids/genetics , Gene Expression/drug effects , Growth Hormone/pharmacology , Intracellular Fluid/metabolism , Mice , Myelin P2 Protein/genetics , Phosphorylation , Proto-Oncogene Proteins c-fos/genetics , Tyrosine/metabolism
7.
Leuk Res ; 9(4): 449-61, 1985.
Article in English | MEDLINE | ID: mdl-3889508

ABSTRACT

Sixty-five cryopreserved leukemic samples from children diagnosed and treated as having acute lymphocytic leukemia (ALL) were retrospectively examined for the presence of lymphoid and myeloid associated antigens by indirect immunofluorescence using monoclonal antibodies. Expectedly, the majority of these specimens expressed antigens known to be expressed on lymphoid, and not myeloid malignancies. These included the common acute lymphoblastic leukemia antigen (CALLA), the p32 B-cell associated antigen, and T-cell associated antigens. Leukemic cells from the 8 remaining patients expressed antigens known to be present on both myeloid and lymphoid leukemias. These included HLA/DR, and the antigens identified by BA-1 and BA-2. Cells from 2 of these 8 patients reacted with antibodies that define antigens present on normal and malignant myeloid cells. Both specimens reacted with 1G10, an anti-granulocyte antibody, and one reacted with 5F1 which reacts with monocytes, nucleated red blood cells, megakaryocytes and platelets. One of these patients relapsed while receiving ALL therapy, and the morphology of her leukemic cells became characteristic of acute monocytic leukemia (AMoL). The second patient failed ALL therapy but responded to standard acute nonlymphocytic leukemia (ANLL) therapy, clearing her peripheral blasts. Thus these studies confirm that cell surface phenotyping with monoclonal antibodies can recognize ALL cells that express myeloid rather than lymphoid associated antigens and demonstrate that the malignant cells display a clinical behavior consistent with the diagnosis of ANLL.


Subject(s)
Antibodies, Monoclonal , Granulocytes/immunology , Leukemia, Lymphoid/diagnosis , Lymphocytes/immunology , Adolescent , Antigens/immunology , Asparaginase/therapeutic use , Child , Female , Fluorescent Antibody Technique , Humans , Infant , Leukemia, Lymphoid/drug therapy , Male , Prednisone/therapeutic use , Prognosis , Vincristine/therapeutic use
8.
Leuk Lymphoma ; 9(3): 177-92, 1993 Feb.
Article in English | MEDLINE | ID: mdl-8471977

ABSTRACT

Active immunization against measles, Haemophilus influenza B, tetanus, diphtheria, hepatitis B, influenza, poliomyelitis, and, when indicated varicella and pneumococcus induces long-lasting immunologic protection in most healthy pediatric vaccine recipients. Among children receiving immunosuppressive therapy for cancer, possible early loss of specific immunity acquired from prior vaccination or disease, and likely diminished responsiveness to initial or booster vaccination must be considered. In addition, the safety of vaccine administration requires separate study in this population. Published evidence demonstrates preservation of vaccine-induced antibody titers against tetanus, diphtheria, poliomyelitis and (in children treated for lymphoma) pneumococcus. In contrast, prior immunity to varicella, influenza, and hepatitis B (when naturally acquired), and measles (acquired by vaccination) is compromised during and/or after antineoplastic therapy. Studies of immunologic protection acquired by prior vaccination against hepatitis B, varicella, and H influenza have not been published. The safety of administering toxoids and inactivated vaccines in this population is well documented. In contrast, morbidity must be expected if live attenuated vaccines (oral polio vaccine, attenuated measles vaccine or attenuated varicella vaccine) are administered to children receiving anti-cancer therapy. The risks of using live vaccines should be measured against demonstrable benefits in any vaccine program. The response to initial or booster immunizations against tetanus and diphtheria are similar to those in healthy children. For all other immunizations reviewed, responsiveness is diminished during periods of chemotherapy, more strikingly in children treated for leukemia than for solid tumors. Antibody responses to these vaccines range from slightly blunted (in the case of H influenza B) to marginal (influenza) or completely useless (pneumococcus and hepatitis B in children treated for leukemia).


Subject(s)
Leukemia/immunology , Neoplasms/immunology , Vaccination , Chickenpox/prevention & control , Child , Haemophilus Infections/prevention & control , Haemophilus influenzae/immunology , Hepatitis B/prevention & control , Humans , Influenza, Human/prevention & control , Leukemia/complications , Measles/prevention & control , Neoplasms/complications , Pneumococcal Infections/prevention & control , Poliomyelitis/prevention & control , Tetanus/prevention & control , Vaccination/adverse effects
9.
Biotechnol Prog ; 15(3): 336-46, 1999.
Article in English | MEDLINE | ID: mdl-10356250

ABSTRACT

Human growth hormone (hGH) is a polypeptide with 191 amino acids and a molecular mass of 22 kDa. An hGH analogue was created with a single amino acid substitution (glycine[G] 120 to arginine[R]) in the third alpha-helix of the hGH molecule. This hGH analogue, named hGHG120R, was found to be an hGH antagonist. It is a parenteral drug candidate for treating conditions in which hGH levels are abnormally high, as found in type I diabetics. Previously, a genetically engineered anchorage-dependent mouse L cell line was created that produced and secreted hGHG120R in culture media (Dulbecco's modified Eagle's medium, DMEM) supplemented with 5% NuSerum IV. A multistep downstream process was developed to purify hGHG120R. The process consisted of cell clarification, salt precipitation, membrane ultrafiltration, size exclusion chromatography, reversed phase high-performance liquid chromatography, phase separation, and lyophilization. Here, we present the development of a superior eukaryotic system using a proper combination of genetic elements, cell line, and media formulation. This system is suitable for the large-scale production of the recombinant protein and is superior to the previously developed system in that it increases the specific production rate and at the same time eases the burden of the purification process, in both time and efficiency. Dihydrofolate reductase mutant (DHFR-) Chinese hamster ovary (CHO) cells were used that were stably transfected with an expression vector in which the hGHG120R gene is driven by the relatively strong human cytomegalovirus-early gene regulatory region. The hGHG120R tested to be biologically active. These cells were then adapted to grow in suspension in CHO-S-SFM (serum-free media). High cell densities, typically 2.0 x 10(6) cells/mL were obtained from spinner flask cultures. Partial purification of hGHG120R from CHO cell cultured media revealed that the level of impurities in SFM was significantly lower than the serum-supplemented DMEM. This suggests that the salt precipitation and the SEC step need not be employed in the purification of hGHG120R from SFM. This would result in a reduction of the operating time by 50 h and boost the recovery yield of hGHG120R to 75%.


Subject(s)
Human Growth Hormone/analogs & derivatives , Human Growth Hormone/antagonists & inhibitors , Adaptation, Physiological , Animals , Biotechnology , CHO Cells , Cricetinae , Culture Media, Serum-Free , Human Growth Hormone/genetics , Humans , L Cells , Mice , Recombinant Proteins/biosynthesis , Recombinant Proteins/genetics , Recombinant Proteins/isolation & purification , Transfection , Ultrafiltration
10.
Biotechnol Prog ; 16(2): 222-7, 2000.
Article in English | MEDLINE | ID: mdl-10753447

ABSTRACT

The dependence of filamentous fungal protease secretion on morphology was investigated by employing the recombinant Aspergillus niger strain AB4.1[pgpdAGLAGFP] which contains a gene for the glucoamylase-GFP (green fluorescence protein) fusion protein. Different inoculum levels were used to obtain different sizes of pellet or free mycelia. The extracellular protease activity of the cultures varied with the pellet size and decreased dramatically when the morphology was changed from free mycelia to pellets. The culture with an optimal pellet size of 1.6 mm was obtained from an inoculum of 4 x 10(6) spores/mL. It resulted in a specific protease activity of 158 units/L, only one-third of that in free mycelial growth, and a maximum specific GFP yield of 0.98 mg/g (cell mass) compared to 0. 29 mg/g for free mycelial growth with an inoculum of 10(7) spores/mL. The results indicate that this bioprocessing strategy can be effectively used to inhibit protease activity in filamentous fungal fermentation and thereby to enhance heterologous protein production.


Subject(s)
Aspergillus niger/metabolism , Endopeptidases/metabolism , Recombinant Fusion Proteins/metabolism , Aspergillus niger/genetics , Biotechnology/instrumentation , Biotechnology/methods , Cell Division , Extracellular Matrix/metabolism , Fermentation , Glucan 1,4-alpha-Glucosidase/genetics , Glucan 1,4-alpha-Glucosidase/metabolism , Green Fluorescent Proteins , Luminescent Proteins/genetics , Luminescent Proteins/metabolism , Recombinant Fusion Proteins/genetics
11.
J Investig Med ; 46(4): 168-74, 1998 Apr.
Article in English | MEDLINE | ID: mdl-9635377

ABSTRACT

BACKGROUND: The National Vaccine Injury Compensation Program (NVICP) provides no-fault compensation to victims of serious untoward vaccine reactions under the supervision of the Department of Health and Human Services (HHS). Special Masters of the Court of Federal Claims settle compensation disputes that arise between applicants and program administrators. The majority of published NVICP claim decisions concern disputes over the cause of neurologic illness or unexpected infant death following pertussis vaccination. METHODS: Information was collected from the published decisions to determine the medical characteristics of cases in which injuries were legally attributed to pertussis vaccination. Because of practical and statutory restrictions on the application process and the evolving nature of HHS claim denials, vaccinees in the disputed cases are not representative of all vaccine casualties, or of all NVICP applicants. RESULTS: Injuries were blamed on pertussis vaccine in 542 claims disputed by HHS. Claims asserted that pertussis vaccine caused seizure disorders (333 claims, 189 were awarded compensation), anaphylaxis (7 claims, 6 awards), hypotonic/hyporesponsive episodes or other injuries leading to early death (107 claims, 73 awards), and long-term neurologic disease (51 claims, 18 awards). CONCLUSIONS: Assertions that pertussis vaccine caused unexpected infant death (other than anaphylaxis), seizure disorders, and long-term neurologic damage are inconsistent with epidemiological research. Findings of legal causation may contribute to popular perceptions that pertussis vaccine is a dangerous biological product. By providing compensation for these claimants, however, the NVICP may reduce the number of successful civil suits and thus protect the nation's vaccine supply.


Subject(s)
Pertussis Vaccine/adverse effects , Anaphylaxis/etiology , Humans , Infant , Seizures/etiology , Sudden Infant Death/etiology
12.
Ann R Coll Surg Engl ; 92(5): 379-84, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20385050

ABSTRACT

INTRODUCTION: Minimally-invasive, video-assisted thyroidectomy (MIVAT) was developed to reduce scarring/trauma associated with cervical incisions used in open thyroidectomy. Results from various centres have been published internationally but none from the UK. This study reports the first results from the UK and compares them with other centres. We also aim to compare the results of a single-surgeon experience in a small/moderately-sized hospital to those of larger tertiary centres. PATIENTS AND METHODS: Retrospective analysis of a single surgeon experience in a district general hospital RESULTS: The cohort was 55 patients (52 female, 3 male), mean age 48 years (range, 21-77 years) who had 64 MIVAT procedures. There were 49 hemithyroidectomies (HTs), 2 isthmusectomy, 4 total thyroidectomies (TTs) and 9 completion thyroidectomies (CTs) with median operating time of 86 min (IQR 66-110 min). Individual operating times were HT 85 min (IQR 60-110 min); TT 130 min (IQR 100-140 min) and CT 77 min (IQR 70-98 min). Median operating time was shorter in the second half of this series (76 min vs 92 min; P < 0.001). Length of stay was < 1 day in 92%. Conversions occurred in 6.3% with no haematoma or re-operation. Transient voice change was present in 7 (11%), permanent unilateral recurrent laryngeal nerve palsy in 2 (3%), and transient hypocalcaemia in 2 (3%). CONCLUSIONS: The first results from the UK are similar to those of other international centres. A single-surgeon practice can obtain results comparable to larger tertiary centres provided there is sufficient case-load. MIVAT is safe and effective, but has a steep learning curve with rapid improvement observed within first 30 cases. Future studies should focus on objective assessment of scar/cosmesis and cost-effectiveness. MIVAT is an acceptable alternative to open surgery in highly selected patients.


Subject(s)
Thyroid Neoplasms/surgery , Thyroidectomy/methods , Video-Assisted Surgery/methods , Adult , Aged , Female , Humans , Hypocalcemia/etiology , Intraoperative Period , Length of Stay/statistics & numerical data , Male , Middle Aged , Retrospective Studies , Thyroidectomy/adverse effects , Video-Assisted Surgery/adverse effects , Vocal Cord Paralysis/etiology , Young Adult
13.
Transplant Proc ; 42(10): 3949-50, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21168595

ABSTRACT

Donation after cardiac death donation allows donor pool expansion. The period between withdrawal of treatment and donor a systole is extremely variable; its prolongation often results in unsuccessful organ procurement. We sought to assess a variety of donor variables to determine whether they predicted successful organ retrieval. We included all Donation after Cardiac Death (DCD) retrievals between 2002 and 2009, which were grouped as successful (n = 104) versus unsuccessful (n = 42). Factors that predicted unsuccessful organ procurement included older donor age, donor history of hypertension, higher at withdrawal, and absence of inotropic support. On multivariate analysis, mean arterial pressure retained its significance. Prediction of withdrawal-to-asystole time is complex, but our analysis suggested that donor blood pressure at withdrawal is an important predictor of whether retrieval would be successful.


Subject(s)
Death , Heart Arrest , Tissue and Organ Procurement , Humans , Multivariate Analysis , Retrospective Studies
14.
Transplant Proc ; 42(10): 3947-8, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21168594

ABSTRACT

Donation after cardiac death (DCD) donors provide a valuable source of grafts for renal transplantation. They are exposed to an initial warm ischemic insult, which can affect early function. We sought to compare our initial DCD experience in renal transplantation with a case-matched donation after brain death (DBD) cohort from the same period. We included all DCD transplantations in the first 5 years of the program. A control DBD group was matched with a variety of donor and recipient factors. We demonstrated a significantly increased early dysfunction (DGF and primary nonfunction). DCD graft function was poorer than the DBD equivalent at 1- and 3-years. However, medium-term recipient and graft outcomes were comparable. DCD grafts continue to play a vital role in renal transplantation despite evidence of early graft dysfunction.


Subject(s)
Brain Death , Brain Stem/physiopathology , Death , Kidney Transplantation , Tissue Donors , Tissue and Organ Procurement , Cohort Studies , Female , Humans , Male , Middle Aged
15.
Transplant Proc ; 42(10): 3951-3, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21168596

ABSTRACT

Donation after cardiac death (DCD) provides grafts in renal transplantation but is associated with increased early graft dysfunction. Cold ischemia time (CIT) is a factor that is thought to affect outcomes in renal transplantation. We sought to assess the impact of the length of CIT among our DCD cohort of renal transplants performed between April 2002 and December 2009. Since the median CIT was 15.5 hours, we formed two groups CIT < 15.5 (n = 100) and CIT > 15.5 hr (n = 98). We demonstrated an increased incidence of DGF among the extended CIT group, but the long outcomes and the mean graft function were otherwise comparable. In conclusion, CIT affects early graft function; every effort should be made to minimize it in renal transplantation using DCD kidneys.


Subject(s)
Cryopreservation , Death , Ischemia , Kidney Transplantation , Kidney/blood supply , Tissue and Organ Procurement , Adult , Female , Graft Survival , Humans , Male , Survival Analysis , Time Factors
16.
Transplant Proc ; 42(10): 3954-6, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21168597

ABSTRACT

Organ donation after cardiac death (DCD) provides a valuable supply of grafts for renal transplantation. Age matching of donors to recipients is often used. We sought to determine the impact of age matching on the outcomes among our cohort of DCD renal transplant recipients. Using our institutional database, we gathered information on all DCD renal transplants performed between April 2002 and December 2009. We divided the cohort into two groups based upon the donor:recipient age ratio: age-matched (between 25th and 75th percentiles, n = 99) and non-age-matched (<25th percentile and >75th centile, n = 100). We failed to demonstrate any significant difference between the two groups in terms of early complications or long-term outcome or function. Age matching did not appear to affect graft outcomes, particularly for young donors, but may have a role in older donors.


Subject(s)
Age Factors , Death , Kidney Transplantation , Patient Selection , Tissue Donors , Adult , Cohort Studies , Female , Humans , Male , Middle Aged
17.
Transplant Proc ; 42(10): 3963-5, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21168600

ABSTRACT

With the increase of donation after cardiac death (DCD) now including procurements for not only kidney but also liver, pancreas, and lung transplantations, we analyze whether multiorgan DCD retrievals have a negative impact on immediate and short-term renal transplant outcomes due to increased length of time of explantation of the kidney from the donor and the associated risks of re-warming. We performed a retrospective study of all DCD donors from 2002 to 2009 at a single unit. Immediate and short-term outcomes between kidney-only versus multiorgan retrieval were compared. Cold ischaemia was significant between the two groups (P = .04), but all other variables were nonsignificant. The results show that immediate graft function, rates of acute rejection and graft/recipient survival are comparable when DCD allografts are procured from both multiorgan and kidney-only donors. The comparable outcomes from kidney-only and multiorgan donations in this study may be due to by the highly selective use of donors for multiorgan DCD donation. This selectivity may explain the "better" quality of kidney for these cases in which patients were able to tolerate potentially injurious rewarming.


Subject(s)
Death , Kidney , Tissue Donors , Tissue and Organ Procurement , Treatment Outcome , Adult , Female , Graft Rejection , Graft Survival , Humans , Male , Middle Aged , Retrospective Studies , Survival Rate
18.
Transplant Proc ; 42(10): 3966-7, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21168601

ABSTRACT

Donation after cardiac death (DCD) allows for expansion of the donor pool, however, the process for DCD donation can lead to a donor's physiological instability before asystole. This may have a detrimental effect on graft and patient outcomes. We analyzed all 201 DCD donations at our unit from 2002 to 2009 and compared short versus long durations to asystole around the median time (20 min). Delayed graft function was comparable between the groups (P = .13), primary nonfunction was increased in the long duration to asystole group (P < .0001), and acute rejection was increased in the short duration group (P < .001). Five year patient survival was comparable (P = .6). In conclusion, long duration asystole may have an immediate effect on graft survival, but it has no overall detrimental effect on longer-term outcomes. Further studies are required to investigate the acceptable time to wait from withdrawal to asystole.


Subject(s)
Death , Heart Arrest , Kidney Transplantation , Tissue and Organ Procurement , Adult , Female , Graft Survival , Humans , Male , Treatment Outcome
19.
Transplant Proc ; 42(10): 3960-2, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21168599

ABSTRACT

The United Kingdom has no national sharing scheme for kidneys received from donation after cardiac death (DCD). Therefore, both kidneys retrieved by a transplant team are implanted at a single unit, often sequentially. This study analyzes the impact of a prolonged cold ischaemia time on the second transplanted kidney and the effects on short-term and long-term outcomes in all our DCD renal implants from 2002 to 2009. Cold ischaemia time was significantly longer with the second kidney (P = .04) as was delayed graft function (P = .02). Acute rejection was increased in the first transplanted kidney (P < .001). Five-year patient survival was comparable between groups, but 5-year graft survival was higher in the second transplanted group (P = .04). The results confirm that, provided recipient centers are willing to accept higher initial rates of delayed graft function, it is acceptable to transplant DCD grafts sequentially without jeopardizing long-term graft or recipient outcome.


Subject(s)
Death , Graft Survival , Ischemia , Kidney Transplantation , Kidney/blood supply , Tissue and Organ Procurement , Treatment Outcome , Adult , Female , Humans , Male , Retrospective Studies , Tissue Donors
20.
Pediatr Infect Dis J ; 15(10): 921-2, 1996 Oct.
Article in English | MEDLINE | ID: mdl-8895933
SELECTION OF CITATIONS
SEARCH DETAIL