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  • 1
    ISSN: 1432-1440
    Keywords: Immune complexes ; Renal transplantation ; Rejection episodes ; Morphological types
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a prospective study circulating immune complexes (CIC) were analyzed before and serially after renal transplantation in 141 consecutive patients. CIC were measured using the Raji cell assay as originally described by Theofilopoulos and Dixon. The amount of CIC was expressed as µg heat aggregated human immunoglobulin G (IgG) equivalent/ml serum. The upper limit of normal sera was 25 µg/ml. The values are expressed as geometric means (−1 SD/+1 SD). In 86 of 133 rejection episodes a renal biopsy was performed and the histopathologic changes were semiquantitatively assessed and classified in a cellular or vascular type of rejection. Before transplantation CIC were detected in 104 of 141 patients (73.8%) and the mean value was 65.6 (27.8–154.9) µg/ml. The level of CIC was positively correlated with the number of grafts (r:0.43;P〈0.01) and the occurrence of chronic active hepatitis (r:0.31;P〈0.01). No correlation was found between CIC and the underlying kidney disease, the number of blood transfusions prior to transplantation, and the pre-existing lymphocytotoxic antibodies. Graft survival and number of rejection episodes were not influenced by the level of CIC prior to transplantation. After transplantation CIC were elevated in 60 patients (41%), appeared transiently in 49 patients (35%) and were never detectable in 32 patients (23%). In patients with a graft survival ≦11 months the average and peak post-transplant CIC levels were significantly higher than patients with a graft survival of 12 months: 64.4 (21.8–191.0); 87.7 (26.0–295.8) versus 39.6 (18.4–85.3); 56.8 (21.0–150.1) µg/ml;P〈0.01. There was a positive correlation between CIC and serum creatinine in the post-transplant period (P〈0.001). The histopathologic severity and morphological type of rejection did not correlate with CIC. In patients without rejection episodes CIC were significantly lower: 41.2 (39.6–42.9) than patients with rejection episodes: 61.8 (56.2–68.0);P〈0.05.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 357 (1982), S. 141-150 
    ISSN: 1435-2451
    Keywords: Renal transplantation ; Immunosuppression ; Colitis ; Ischemic colitis ; Cytomegalovirus infection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Vom Dezember 1964 bis Ende Juni 1980 wurden im Universitätsspital Zürich bei 524 Patienten total 596 Nierenallotransplantationen durchgeführt unter ausschließlicher Verwendung von Nieren Frischverstorbener. Bei einer Nachkontrollzeit von minimum 1 $${\raise0.5ex\hbox{$\scriptstyle 1$}\kern-0.1em/\kern-0.15em\lower0.25ex\hbox{$\scriptstyle 2$}}$$ Jahren wurden bei 12 Patienten schwere Colonkomplikationen festgestellt. Sie umfassen 4 Perforationen (eine Sigmadiverticulitis, 1 Cytomegalieulcus des Coecums, 2 ischämische Colitiden), 5 Fälle von ischämischer Colitis ohne Perforation und 3 Patienten mit „erosiver Colitis”, die aber ebenfalls ischämisch gedeutet werden muß. Bei 9 der 12 Patienten war der Colonkomplikation eine hypotone Phase von 4–17 Tage vorausgegangen. Die Häufigkeit der Komplikation von 2 % in unserem Krankengut ist mit der mittleren Komplikationsrate der Literatur von 2,4 % vergleichbar. Auch die Letalität von 75 % entspricht derjenigen anderer Berichte. Der wichtigste ursächliche Faktor der Colonkomplikationen ist die Ischämie; die Verhütung von hypotonen Phasen nach Nierentransplantation ist daher wichtig.
    Notes: Summary From December 1964 to June 1980, 569 kidney allotransplants were performed in 524 patients at the University Hospital in Zurich. Necrokidneys were used exclusively. Twelve of these patients exhibited severe colonic complications: four perforations (1 perforated diverticulitis of the sigmoid, 1 perforation of the cecum during cytomegalovirus infection, 2 cases of ischemic colitis), 5 cases of ischemic colitis without perforation, and 3 patients with erosive colitis. In 9 of the 12 patients, hypotonic episodes were noted 4–17 days previously. The 2 % complication rate in our patients is comparable with the mean rate of complications mentioned in the literature (2.4 %). The lethality of 75 % also corresponds with the results of other authors. The most important pathogenetic factor for colonic complications is ischemia; prevention of hypotonic episodes after renal transplantation is therefore mandatory.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1440
    Keywords: Renal transplantation ; Immunosuppression ; Cyclosporine A ; Immunologic monitoring ; T lymphocytes ; Cell surface antigens ; Monoclonal antibodies ; Flow cytometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The lymphocyte subsets in the peripheral blood were examined 3 times a week in 17 patients receiving a cadaveric renal allograft using 2-color flow cytometry and several combinations of monoclonal antibodies. Patients who experienced a rejection crisis (n=12) had a significantly higher CD4/CD8-ratio (2.72±1.26 mean±SD) than patients with stable graft function (1.76±1.33, p〈0.05). 9/12 patients showed 0–3 days prior to the rejection episode an increase of the CD4/CD8-ratio (≥0.5) and/or a high ratio (≥2.5) with a decrease following antirejection therapy. The activation markers HLA-DR and IL-2 receptor on T cells were increased only during 3/12 rejection episodes. Patients with rejections resistant to prednisone pulse therapy (n=6) had significantly more lymphocytes/mm3 in the peripheral blood (1111.7±597.5) than successfully treated patients (n=6, 336.7±196.0, p〈0.02). Antirejection therapy with prednisone pulses and/or antithymocyte globuline resulted in a significant decrease of T lymphocytes (CD3+) with a selective reduction of T helper/inducer cells (CD4+). 6 months after renal transplantation the patients had a higher percentage of suppressor/cytotoxic cells (CD8+) compared to the pretransplant values (26.3±10.9% vs 17.7±6.2%, p〈0.02) and blood donors (16.3±6.2%, p〈0.01). Furthermore the percentage of T helper cells (CD4+/CD28−) was significantly higher and the T suppressor-inducer cells (CD4+/CD28+) were significantly lower compared to the controls. Serial flow cytometric determinations of lymphocyte subsets in renal allograft recipients may be helpful in some cases although rejection episodes could not be predicted in the individual patient.
    Type of Medium: Electronic Resource
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