Background: The portal venous and enteric drainage (P-E) technique was developed to avoid systemic hyperinsulinemia and bladder related complications. Pancreas retransplantation (Re-Tx) is an important option for patients who have lost their primary grafts. It is unknown whether the P-E technique can be repeated safely in patients who have lost their first pancreas transplant.
View Article and Find Full Text PDFLung injury is a major cause of patient morbidity in acute pancreatitis. The purpose of this study was to examine the mechanism of pulmonary infiltration and lung injury in acute pancreatitis. Mice were fed a choline-deficient/ethionine-supplemented (CDE) diet for 144 hours to induce severe acute pancreatitis.
View Article and Find Full Text PDFIn an effort to ameliorate the problem of orthostatic hypotension in pancreas transplant patients, current medical management consists of maximizing the patient's hydration, altering antihypertensives, increasing sodium intake, initiation of fludrocortisone, compression stockings, and behavioral modifications. Despite these medical interventions, a subset of patients remains symptomatic. Midodrine (ProAmatine), an alpha-adrenergic agonist, was approved for the treatment of symptomatic orthostatic hypotension in the US.
View Article and Find Full Text PDFBackground: Most pancreas transplants are performed with systemic venous delivery of insulin and bladder drainage of the exocrine secretions (systemic-bladder [S-B]). To develop a more physiologic procedure, we performed pancreas transplantations with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric [P-E]).
Methods: During an 11-month period, we prospectively alternated 32 consecutive pancreas transplant recipients to either S-B (n = 16) or P-E (n = 16) drainage with standardized immunosuppression.
Objective: To determine whether expression of P- and E-selectin molecules is associated with the development of systemic organ manifestations in acute pancreatitis (AP).
Summary Background Data: Overproduction of inflammatory cytokines in AP induces expression of adhesion molecules, which may lead to increased leukocytic infiltration and tissue damage. Understanding the temporal expression of these molecules could afford better measures for therapeutic intervention.
Background: The introduction of potent new immunosuppressive agents may allow simultaneous kidney-pancreas transplantation to be performed without antilymphocyte induction.
Methods: We analyzed 30 simultaneous kidney-pancreas transplantations receiving tacrolimus, mycophenolate mofetil, and steroids without without antilymphocyte induction. Eighteen patients underwent pancreas transplantation with portal-enteric (P-E) drainage and the remaining 12 had systemic bladder (S-B) drainage.
Introduction: Previous studies have suggested that African-American (AA) ethnicity is a risk factor for rejection and graft loss after kidney transplantation. However, little data is available regarding outcomes after simultaneous kidney pancreas transplantation (SKPT) in AA recipients. The objective of this study was to compare the outcomes of SKPT in AA patients to matched Caucasian patients as controls.
View Article and Find Full Text PDFBackground: Transplantation has been shown to improve cardiorespiratory reflex measures of autonomic function. However, there are limited data on how kidney or kidney-pancreas transplantation influence continuous autonomic modulation of heart rate and the clinical utility of 24-hr heart rate variability (HRV) monitoring.
Methods: Ninety nondiabetic kidney and 30 diabetic kidney-pancreas transplant recipients underwent 24-hr Holter monitoring before and again at 6 and 12 months posttransplantation.
Unlabelled: From 1989 to 1997, we performed 159 pancreas transplantations (PTXs), including 117 simultaneous kidney PTX (SKPT), 25 PTXs alone (PTA), and 17 sequential PTXs after kidney transplantations (PAKT). A total of 73 PTXs were performed with systemic-bladder (S-B) and 86 with portal-enteric (P-E) drainage. The need for allograft pancreatectomy (PCTY) may be considered as an index of technical morbidity after PTX.
View Article and Find Full Text PDFHypothesis: The levels of intestinal interleukin 10 and interleukin 4, inhibitors of intercellular adhesion molecule-1 (ICAM-1) expression, decline with total parenteral nutrition (TPN). These cytokine changes induced by lack of enteral nutrition may increase ICAM-1 expression, resulting in polymorphonuclear neutrophil accumulation in intestine.
Design: Prospective randomized experimental trials.
The UT-Memphis Group has made a number of important contributions to the field of PTX including: 1. Pioneering studies on the effects of PTX on autonomic neuropathy;(15, 16) 2. Comprehensive reports dealing with quality of life after PTX;(17, 18, 38) 3.
View Article and Find Full Text PDFBackground: Despite recent advances, surgical complications remain an important source of morbidity after pancreas transplantation (PTX). Several previous studies have delineated the surgical complications after PTX with systemic-bladder (S-B) drainage, but data are limited regarding the incidence and outcomes of surgical complications after PTX with portal-enteric (P-E) drainage.
Study Design: We retrospectively studied surgical complications after 83 vascularized PTXs with P-E drainage in 79 patients (65 simultaneous kidney-PTXs [SKPT] and 18 solitary PTXs [SPT], 8 pancreas alone and 10 pancreas after kidney transplantation).
Unlabelled: Correlation of histology to rejection reversal: A Thymoglobulin Multicenter Trial report
Background: Histology may provide a link between clinical response to antirejection therapy and graft function. In a subset of centers, renal biopsy was a secondary end point for the Thymoglobulin Multicenter Trial.
Methods: Thirty-eight patients had a protocol biopsy one to two weeks following the end of therapy.
In this study intended to establish equivalence between two antibody therapies for acute rejection in kidney transplant recipients, it was important to develop a rigorous protocol. Assurance of the presence of acute rejection was imperative. Therefore, due to the lack of literature support for clinical assessment of renal dysfunction, histologic diagnosis of acute rejection was required for enrollment in the study.
View Article and Find Full Text PDFObjective: To report initial experience with the combination of a novel technique of portal-enteric pancreas transplantation with newer immunosuppressive strategies that eliminate antilymphocyte induction therapy.
Background: A new surgical technique of pancreas transplantation has been developed with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric). The introduction of potent immunosuppressive agents may allow simultaneous kidney and pancreas transplants (SKPT) to be performed without antilymphocyte induction.
We performed retrospective flow cytometry crossmatch (FCXM) on 106 renal graft recipients who were transplanted based on current T cell negative serologic crossmatch. T and B cell FCXMs were performed on current and historical peak reactive post-transplant sera using 1024-channel flow cytometer and the shift in median channel fluorescence (SMCF) over the negative control was calculated. Cut-off values for a positive T and B crossmatch, > 40 and > 80 SMCF, respectively, were determined based on previous retrospective analysis of the data in the context of clinical outcome in our center, and were 1.
View Article and Find Full Text PDFPediatr Nephrol
September 1998
In past years, many pediatric transplant centers found African-American renal transplant recipients to have poor graft survival. Since 1991 anti-lymphocyte induction therapy has been routinely used for pediatric cadaveric (CAD) and living-related donor (LRD) renal allograft recipients at the University of Tennessee, Memphis. Sixteen African-American first renal allograft recipients received induction therapy: 11 CAD allografts (10 OKT3, 1 ATGAM) and five LRD (all ATGAM).
View Article and Find Full Text PDFSudden cardiac death occurring in patients with end-stage renal disease (ESRD) may be related to poor autonomic function (AF). It is not known whether patients having a sudden death can be identified by commonly used AF evoked tests or if a newer test evaluating heart rate variability (HRV) with power spectral analysis can better distinguish at-risk patients. This study sought to characterize AF in patients awaiting kidney transplantation, to identify factors associated with poor AF and sudden death, and to compare evoked versus 24-hour measures of cardiac AF.
View Article and Find Full Text PDFBackground: Thymoglobulin, a rabbit anti-human thymocyte globulin, was compared with Atgam, a horse anti-human thymocyte globulin for the treatment of acute rejection after renal transplantation.
Methods: A multicenter, double-blind, randomized trial with enrollment stratification based on standardized histology (Banff grading) was conducted. Subjects received 7-14 days of Thymoglobulin (1.
Portal-enteric (PE) transplantation of the pancreas allograft provides maintained physiologic drainage, and theoretically the portal delivery of transplantation antigens may have beneficial effects on the graft acceptance leading to improved graft survival. To determine whether the technique of pancreas placement affects the incidence of acute rejection we reviewed our experience in technically successful PE and systemic-bladder (SB) drained simultaneous pancreas and kidney (SPK) transplants performed between 1989 and 1994. Forty-seven recipients were included (SB = 30, PE = 17).
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