101
|
Cheung AH, Matas AJ, Gruessner RG, Dunn DL, Moudry-Munns KC, Najarian JS, Sutherland DE. Should uremic diabetic patients who want a pancreas transplant receive a simultaneous cadaver kidney-pancreas transplant or a living related donor kidney first followed by cadaver pancreas transplant? Transplant Proc 1993; 25:1184-5. [PMID: 8442081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
102
|
Troppmann C, Almond PS, Payne WD, Dunn DL, Gores PF, Gruessner RW, Sutherland DE, Matas AJ, Najarian JS. Does acute tubular necrosis affect renal transplant outcome? The impact of rejection episodes. Transplant Proc 1993; 25:905. [PMID: 8442263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
103
|
Nakai I, Oka T, Field JM, Perry E, Najarian JS, Sutherland DE, Brayman KL. Occurrence and prevention of graft-vs-host disease after pancreaticoduodenal transplantation in the BB rat. Transplant Proc 1993; 25:965-7. [PMID: 8442282 DOI: pmid/8442282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
104
|
Gruessner A, Gruessner R, Moudry-Munns K, Dunn D, Najarian JS, Sutherland DE. Influence of multiple factors (age, transplant number, recipient category, donor source) on outcome of pancreas transplantation at one institution. Transplant Proc 1993; 25:1303-5. [PMID: 8442121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
105
|
Jones JW, Matas AJ, Gillingham KJ, Gores PF, Payne WD, Gruessner RF, Sutherland DE, Najarian JS. Employment and disability after renal transplantation. Transplant Proc 1993; 25:1368. [PMID: 8442145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
106
|
Pasquale MD, Abrams JH, Najarian JS, Cerra FB. Use of Greenfield filters in renal transplant patients--are they safe? Transplantation 1993; 55:439-42. [PMID: 8434401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
107
|
Brayman KL, Nakai I, Field J, Lloveras JJ, Farney A, Najarian JS, Sutherland DE. Intrathymic islet allografts prevent hyperglycemia and autoimmune beta-cell destruction in BB rats following transplantation in the prediabetic period. Transplant Proc 1993; 25:284-5. [PMID: 8438301 DOI: pmid/8438301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
MESH Headings
- Aging/physiology
- Animals
- Autoimmune Diseases/prevention & control
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 1/surgery
- Hyperglycemia/prevention & control
- Islets of Langerhans/immunology
- Islets of Langerhans/pathology
- Islets of Langerhans Transplantation/immunology
- Islets of Langerhans Transplantation/physiology
- Prediabetic State/immunology
- Prediabetic State/pathology
- Prediabetic State/surgery
- Rats
- Rats, Inbred BB
- Rats, Inbred Lew
- Rats, Inbred WF
- Thymus Gland
- Transplantation, Heterotopic/immunology
- Transplantation, Heterotopic/physiology
- Transplantation, Homologous/immunology
- Transplantation, Homologous/physiology
Collapse
|
108
|
Moss A, Almond PS, Matas AJ, Gillingham K, Najarian JS. Predictors of improved outcome in second pediatric renal transplant recipients. Transplant Proc 1993; 25:597. [PMID: 8438429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
109
|
Gruessner RW, Stephanian E, Dunn DL, Gruessner AC, Najarian JS, Sutherland DE. Cystoenteric conversion after whole pancreaticoduodenal transplantation: indications, risk factors, and outcome. Transplant Proc 1993; 25:1179-81. [PMID: 8442079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
110
|
Basadonna GP, Matas AJ, Gillingham KJ, Payne WD, Dunn DL, Sutherland DE, Gores PF, Gruessner RW, Arrazola L, Najarian JS. Relationship between early vs late acute rejection and onset of chronic rejection in kidney transplantation. Transplant Proc 1993; 25:910-1. [PMID: 8442265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
111
|
Flores HC, Cromwell JW, Leventhal JR, Najarian JS, Matas AJ. Does previous breast feeding affect maternal donor renal allograft outcome? A single-institution experience. Transplant Proc 1993; 25:212. [PMID: 8438274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
112
|
Kaufman DB, Matas AJ, Arrazola L, Gillingham KJ, Sutherland DE, Payne WD, Dunn DL, Gores PF, Najarian JS. Transplantation of kidneys from zero haplotype-matched living donors and from distantly related and unrelated donors in the cyclosporine era. Transplant Proc 1993; 25:1530-1. [PMID: 8442176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
113
|
Almond PS, Matas AJ, Gillingham K, Dunn DL, Payne WD, Gores P, Gruessner R, Najarian JS. Predictors of chronic rejection in renal transplant recipients. Transplant Proc 1993; 25:936. [PMID: 8442273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
114
|
Almond PS, Matas AJ, Nakhleh RE, Morel P, Troppmann C, Najarian JS, Chavers B. Renal transplantation for infantile cystinosis: long-term follow-up. J Pediatr Surg 1993; 28:232-8. [PMID: 8437088 DOI: 10.1016/s0022-3468(05)80282-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Renal transplantation for infantile cystinosis corrects renal failure and prolongs survival. However, after transplantation, the disease may develop in the allograft and continue to progress in nonrenal organs. We studied seven children (6 boys, 1 girl) with infantile cystinosis who received 11 renal transplants (3 cadaver, 8 living-related) between May 1969 and December 1986. The age at transplant ranged from 6 to 12 years (mean, 9.1 years). Four children received second renal transplants at a mean age of 17 years (range, 16 to 22 years). The mean period of follow-up was 138 +/- 47 months. Three children received cysteamine therapy prior to transplantation. Nonrenal complications of infantile cystinosis present before transplantation were photophobia (n = 3), corneal crystals (n = 5), hypothyroidism (n = 1), rickets (n = 6), and short stature (n = 7). Graft and patient survival did not differ from controls matched for the time of transplantation. Two patients died (1 pneumococcal sepsis, 1 respiratory failure due to pulmonary fibrosis) with functioning grafts 5 and 14 years posttransplant. Complications that developed posttransplant included photophobia (n = 1), corneal crystals (n = 2), hypothyroidism (n = 4), polyneuropathy (n = 1), pulmonary fibrosis (n = 1), abnormal electroencephalogram without clinical seizures (n = 1), bladder stones (n = 1), and diabetes mellitus (n = 2). One patient received a corneal transplant. All seven children failed to show improvement in growth following transplantation. Cystine crystals are present in graft-infiltrating cells, but do not seem to affect kidney allograft function.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
|
115
|
Canafax DM, Carleton BC, Matas AJ, Payne WD, Dunn DL, Sutherland DE, Najarian JS. Effects of three immunosuppressive drug protocols on cadaver renal transplantation costs after 4 years of therapy. Transplant Proc 1993; 25:1692-3. [PMID: 8442239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
116
|
Gores PF, Najarian JS, Stephanian E, Lloveras JJ, Kelley SL, Sutherland DE. Insulin independence in type I diabetes after transplantation of unpurified islets from single donor with 15-deoxyspergualin. Lancet 1993; 341:19-21. [PMID: 8093268 DOI: 10.1016/0140-6736(93)92484-b] [Citation(s) in RCA: 129] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Islet transplantation has been slow to develop as a therapy for type I diabetes mellitus. Conventional immunosuppression does not protect islet allografts from early failure and by current techniques the yield of purified islets from a single pancreas is inadequate or only marginally in excess of the number needed to sustain normoglycaemia. We transplanted unpurified islets from a single pancreas concomitantly with a kidney to two uraemic diabetic patients. The novel agent 15-deoxyspergualin, along with antilymphocyte globulin, was used for induction immunosuppression, and azathioprine, prednisone, and cyclosporin for maintenance. Islet function has been sustained in both, and the second patient is insulin-independent and euglycaemic more than 6 months after transplantation.
Collapse
|
117
|
Matas AJ, Najarian JS. The role of HLA typing in clinical kidney transplants: 30 years later. CLINICAL TRANSPLANTS 1993:428-430. [PMID: 7918175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
118
|
Nakai I, Oka T, Field JM, Najarian JS, Sutherland DE, Brayman KL. Neonatal tolerance induction in diabetes-prone BB rats as a model for donor-specific pancreas transplantation during adulthood. Transplant Proc 1992; 24:2902. [PMID: 1465991 DOI: pmid/1465991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
119
|
Stephanian E, Gruessner RW, Brayman KL, Gores P, Dunn DL, Najarian JS, Sutherland DE. Conversion of exocrine secretions from bladder to enteric drainage in recipients of whole pancreaticoduodenal transplants. Ann Surg 1992; 216:663-72. [PMID: 1466620 PMCID: PMC1242713 DOI: 10.1097/00000658-199212000-00008] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Between September 1984 and August 1991, 265 whole pancreaticoduodenal transplants were done at our institution, with bladder drainage of exocrine secretions through a duodenocystostomy. Seventeen patients subsequently underwent conversion from bladder to enteric drainage at 2 to 64 months after transplant. Eight conversion procedures were done to correct chronic intractable metabolic acidosis due to bicarbonate loss from the allograft: seven to alleviate severe dysuria, presumed secondary to the action of graft enzymes on uroepithelium; one to prevent recurrent allograft pancreatitis, presumed secondary to back pressure from the bladder; and one because of graft duodenectomy for severe cytomegalovirus duodenitis with perforation. None were done to correct technical complications from the initial transplant operation. The conversions were done by dividing the graft duodenocystostomy, then re-establishing drainage through a graft duodenal-recipient jejunal anastomosis. A simple loop of recipient jejunum was used for the duodenojejunostomy in 15 cases, and a Roux limb in two. One of those two cases had a previously created Roux limb that was available for use. The other was in the patient who underwent graft duodenectomy and subsequent mucosa-to-mucosa anastomosis of the pancreatic duct to a newly created Roux limb of jejunum. All patients experienced relief of their symptoms after operation. Two patients had surgical complications (12%), an enterotomy in one case, which was closed operatively, and an enterocutaneous fistula in the other case, which healed spontaneously with bowel rest and parenteral nutrition. The drawback to conversion is loss of urine amylase as a marker for rejection, particularly in recipients of solitary pancreas grafts (n = 5). In recipients of simultaneous pancreas-kidney (SPK) allografts (n = 12), the kidney can still be used to monitor for rejection (two with follow-up < 1 year, 10 with follow-up > 1 year). None of our solitary pancreas recipients, however, have lost graft function (follow-up, 10 to 36 months). The only pancreas allograft loss was in an SPK recipient who also rejected the kidney 6 months after conversion. She received a second SPK transplant with enteric drainage, and is insulin independent and normoglycemic 10 months after retransplantation. Patients converted for metabolic acidosis tended to have impaired renal function (mean creatinine, 2.14 +/- 0.98 mg/dL at time of conversion) due to chronic rejection, progression of native kidney diabetic nephropathy, or cyclosporine toxicity, and possibly could not compensate for bicarbonate loss from the pancreas allograft.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
|
120
|
|
121
|
Abstract
The perioperative and long-term risks for living kidney donors are of concern. We have studied donors at the University of Minnesota 20 years or more (mean 23.7) after donation by comparing renal function, blood pressure, and proteinuria in donors with siblings. In 57 donors (mean age 61 [SE 1]), mean serum creatinine is 1.1 (0.01) mg/dl, blood urea nitrogen 17 (0.5) mg/dl, creatinine clearance 82 (2) ml/min, and blood pressure 134 (2)/80 (1) mm Hg. 32% of the donors are taking antihypertensive drugs and 23% have proteinuria. The 65 siblings (mean age 58 [1.3]) do not significantly differ from the donors in any of these variables: 1.1 (0.03) mg/dl, 17 (1.2) mg/dl, 89 (3.3) ml/min, and 130 (3)/80 (1.5) mm Hg, respectively. 44% of the siblings are taking antihypertensives and 22% have proteinuria. To assess perioperative mortality, we surveyed all members of the American Society of Transplant Surgeons about donor mortality at their institutions. We documented 17 perioperative deaths in the USA and Canada after living donation, and estimate mortality to be 0.03%. We conclude that perioperative mortality in the USA and Canada after living-donor nephrectomy is low. In long-term follow-up of our living donors, we found no evidence of progressive renal deterioration or other serious disorders.
Collapse
|
122
|
Basadonna G, Matas AJ, Najarian JS. Kidney transplantation in diabetic patients: the University of Minnesota experience. KIDNEY INTERNATIONAL. SUPPLEMENT 1992; 38:S193-6. [PMID: 1405374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
123
|
|
124
|
Brayman KL, Nakai I, Field MJ, Lloveras JJ, Jessurun J, Najarian JS, Sutherland DE. Evaluation of intrathymic islet transplantation in the prediabetic period. Surgery 1992; 112:319-26. [PMID: 1641770 DOI: pmid/1641770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Beta-cell destruction in type I diabetes mellitus results from a chronic autoimmune process. Exposure of thymic T cells to islet antigens during the prehyperglycemic phase of diabetes may alter the likelihood of autoimmune damage to beta cells in the native pancreas. Thus we evaluated whether prophylactic major histocompatibility complex (MHC)-incompatible intrathymic islet allografts could prevent hyperglycemia and native pancreatic beta-cell destruction. METHODS At 4 to 6 weeks of age, diabetes-prone BioBreeding rats received intrathymic injection of 1500 to 2000 noncultured MHC-incompatible Lewis islets. No immunosuppression was administered. Age-matched littermates underwent intrathymic injection of saline solution. RESULTS None of 13 BioBreeding rat recipients of prophylactic intrathymic Lewis islet allografts became hyperglycemic versus 13 of 13 control rats (p less than 0.001). The age at onset of diabetes in the control group ranged from 77 to 104 days (mean, 86 days). Normoglycemia in recipients of intrathymic islet allografts persisted for greater than 8 months after transplantation, and thymectomy (graft removal) did not precipitate hyperglycemia. CONCLUSIONS Prophylactic intrathymic MHC-incompatible islet allografts effectively prevent hyperglycemia and native beta-cell destruction in an animal model of autoimmune diabetes. Rejection and autoimmune destruction of intrathymic MHC-incompatible islet allografts were not seen after transplantation in the prediabetic (prehyperglycemic) period. Intrathymic islet allografts at an early age (before puberty) preserve native beta-cell function and may prevent or retard thymic atrophy.
Collapse
|
125
|
Najarian JS, Sutherland DE. Pancreas transplantation--1991. Transplant Proc 1992; 24:1293-6. [PMID: 1496566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|