| 1. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Adjuvant treatment with ursodeoxycholic acid reduces acute rejection after liver transplantation.
- 1992
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Ingår i: Transplant international : official journal of the European Society for Organ Transplantation. - 0934-0874. ; 5 Suppl 1
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Tidskriftsartikel (refereegranskat)abstract
- Acute rejection, occurring with a reported frequency of 50-70%, is still a dominating problem after liver transplantation. Medication with ursodeoxycholic acid (UDCA) has beneficial effects in different cholestatic conditions and has also been shown to reduce HLA class I antigen expression on hepatocytes in patients with PBC. Since August 1989 we have consecutively treated all patients with primary graft function with UDCA (n = 41). Patients transplanted in the first half of 1989 served as a control group (n = 8). All patients in this study were given sequential quadruple drug immunosuppression. The treatment group were given oral UDCA 10 mg/kg per day. During the first postoperative month, 17% of the UDCA-treated patients had an episode of acute rejection compared with 75% of the control patients (P < 0.01). Liver biochemistry tests 1 month postoperatively were significantly better in patients treated with UDCA. The results suggest that adjuvant treatment with UDCA reduces acute liver graft rejection.
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| 2. |
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| 3. |
- Felldin, M., et al.
(författare)
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Donor monoclonal gammopathy may cause lymphoproliferative disorders in solid organ transplant recipients
- 2016
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Ingår i: American Journal of Transplantation. - : Wiley-Blackwell Publishing Inc.. - 1600-6135 .- 1600-6143. ; 16:9, s. 2676-2683
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Tidskriftsartikel (refereegranskat)abstract
- Prior research on donor monoclonal gammopathy of undetermined significance (MGUS) has been inadequate regarding the risk for lymphoproliferative disease in solid organ transplantation recipients. Seven organ recipients from two different donors developed lymphoproliferative disease. The origin of the malignancy was determined by use of microsatellite analysis, and the plasma of the two donors was analyzed with the use of electrophoresis. The clinical courses of the seven recipients were followed for 36–60 months. One donor transmitted lymphoplasmacytic lymphoma to two kidney recipients and MGUS to a liver recipient, all IgMκ. A second donor caused IgGλ myeloma in two kidney and one liver recipient, and IgGλ gammopathy in a heart recipient. Transplant nephrectomy was performed in three kidney recipients and remission was achieved. The fourth kidney recipient has kept the graft and the disease has progressed. The liver recipient died from myeloma. There were no clinical signs of lymphoproliferative disease in the donors, but retrospective serum analyses showed M‐components, IgMκ (37 g/L) and IgGλ (8 g/L). Donors with MGUS may cause donor‐transmitted malignancies via passenger lymphocytes/plasma cells in solid organ recipients. The results call for a large register study of the incidence of donor MGUS and lymphoproliferative disease in their recipients.
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| 4. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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A possible role of ursodeoxycholic acid in liver transplantation.
- 1994
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Ingår i: Scandinavian journal of gastroenterology. Supplement. - 0085-5928. ; 204, s. 62-4
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Forskningsöversikt (refereegranskat)abstract
- There are many different causes of graft dysfunction and cholestasis after liver transplantation. These include non-primary function, preservation and reperfusion injury, acute rejection, artery thrombosis, drug toxicity, bile leakage, and bile duct stenosis. Medication with ursodeoxycholic acid (UDCA) has beneficial effects in different cholestatic conditions. The initial rationale for its use after liver transplantation was to alter the bile acid pool to a more atoxic composition, as liver transplantation can be associated with cholestasis and can stimulate the initial bile production. We have consecutively treated 41 patients with primary graft function with UDCA. During the first postoperative month, 17% of the UDCA treated patients had an episode of acute rejection compared with 75% of a historical control group of 8 patients. The results suggest that adjuvant treatment with UDCA reduces acute liver graft rejection. This has to be confirmed by controlled prospective trials; one is presently being carried out in the Nordic countries. Several studies have indicated an immunomodulating capacity of this bile acid and we have recently reported our results from a heart transplant model in the rat, where treatment with UDCA prolonged graft survival. Improvement in surgical technique and postoperative care as well as immunosuppressive treatment has improved the results of liver transplantation. Acute rejection is nowadays a dominating problem after liver transplantation and the inclusion of UDCA may reduce morbidity.
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| 5. |
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| 6. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Biliary excretion of different sized polyethylene glycols in the cat.
- 1990
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Ingår i: Journal of hepatology. - 0168-8278. ; 11:2, s. 215-20
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Tidskriftsartikel (refereegranskat)abstract
- Polyethylene glycol (PEG) 900 is excreted more extensively into bile than mannitol and erythritol. In this study, the biliary recovery of intravenously injected marker molecules was analysed in anaesthetised cats with ligated renal pedicles. It was demonstrated that among polyethylene glycols sized 292-1250 Da, the species sized 1074 Da was maximally excreted in the bile. After 5 h, about 12% of the injected amount of this molecular species was recovered in bile. Both larger and smaller polyethylene glycol molecules had a lower biliary excretion. The distribution of different sized PEGs in the range 766-1250 Da in serum was fairly constant and cannot explain the recovery profile in bile. 14C-Labelled mannitol was recovered in bile to the extent of 0.7% of the amount given i.v. after 5 h, a figure that corresponds to that obtained for polyethylene glycol with a size of 370 Da. Bile/plasma ratios during steady state conditions of labelled PEG 450, PEG 900, PEG 2500 and PEG 4000 were 10, 36, 3 and 4, respectively. The results may be tentatively explained by restricted passage of the larger PEG molecules into the canaliculi, and leakage of the smaller molecules from bile back to plasma.
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| 7. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Hepatic excretion and metabolism of polyethylene glycols and mannitol in the cat.
- 1993
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Ingår i: Journal of hepatology. - 0168-8278. ; 17:1, s. 48-55
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Tidskriftsartikel (refereegranskat)abstract
- The biliary clearances of fluid phase markers like erythritol and mannitol have been used to estimate canalicular bile flow. Larger fluid phase marker molecules like polyethylene glycol (PEG) 900 are excreted more extensively into bile, and it has been suggested that the biliary clearance of these give a more accurate measure of canalicular water flux than those of erythritol and mannitol. In this study, the biliary excretion of PEG 900 was compared with that of mannitol during choleresis induced by either sodium taurocholate or secretin. The biliary excretion of PEG 900 exceeded that of mannitol by a factor of 94. The biliary clearance of these markers was not influenced by secretin-induced choleresis. Using ion-exchange chromatography and fast atom bombardment mass spectrometry (FABMS) it was demonstrated that 26% of the PEG molecules are excreted into bile after oxidation to carboxylic acids, whereas sulphate conjugation is negligible. The majority of the PEG molecules (74%) were secreted unchanged, which supports the hypothesis of a mainly passive movement of PEG with the water flux into bile. FABMS showed an enrichment of larger PEG molecules in bile, which supports a previous finding that among differently sized PEGs the 1074-Da molecules have the highest biliary excretion.
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| 8. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Hepatobiliary compensation for the loss of gallbladder function after cholecystectomy. An experimental study in the cat.
- 1990
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Ingår i: Scandinavian journal of gastroenterology. - 0036-5521. ; 25:3, s. 307-14
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Tidskriftsartikel (refereegranskat)abstract
- The side effects of the removal of a functioning gallbladder are surprisingly few, and it has been suggested, but never demonstrated, that the hepatobiliary tract then adjusts to compensate for the loss of gallbladder function. In this study the effects of cholecystectomy on bile acid kinetics, bile flow, and biliary clearance of mannitol were studied in cats 6-8 weeks after cholecystectomy. An enhanced recycling rate of a diminished bile acid pool was found. The bile flow was reduced and the bile acid concentration in hepatic bile was increased, but fasting bile acid secretion rate was not changed. Both when the bile acid secretion rate was reduced by drainage via an acute bile fistula and when it was enhanced by intravenous infusion of glycocholic acid, there was a lower bile acid-independent flow in the cholecystectomy group. This reduced bile flow after cholecystectomy was not explained by the higher proportion of deoxycholic acid present in the bile of the cholecystectomized animals. Biliary clearance of mannitol, which is supposed to reflect the canalicular inflow, was not reduced, indicating that the reduction in bile flow is explained by a reduced fluid secretion or an enhanced fluid reabsorption in the bile ductules and ducts after cholecystectomy. In this manner the bile ducts compensate for the loss of the absorptive function of the gallbladder after cholecystectomy.
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| 9. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Intussusception at four separate locations in the small intestine. Case report.
- 1988
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 154:7-8, s. 485-6
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Tidskriftsartikel (refereegranskat)abstract
- A case of intussusception at four different locations in the small intestine is reported. Operative reduction of the interponates were performed with an uneventful postoperative course. The treatment of intussusception in adults is discussed and the literature is reviewed.
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| 10. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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The bile acid independent flow is reduced in the transplanted liver.
- 1992
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Ingår i: Transplant international : official journal of the European Society for Organ Transplantation. - 0934-0874. ; 5 Suppl 1
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Tidskriftsartikel (refereegranskat)abstract
- Bile secretion is an important indicator of liver graft function. Reports on bile formation by the transplanted liver with stable function some months after operation are scarce. In this study bile flow, bile salt secretion rate (BSSR) and biliary clearance of polyethylene glycol (PEG) 900, a marker of canalicular bile flow, were studied in a group of liver-transplanted (LTX) patients (n = 8) 3-6 months after transplantation. A group of cholecystectomized patients with indwelling T-tubes (n = 6) served as a control group. Both groups were treated with oral ursodeoxycholic acid (500 mg/day). On the day of the study bile was drained for 6 h by gravity and four-hourly samples were used in the calculations. The relation between bile flow and BSSR analysed with linear regression showed a reduced bile acid independent flow in the liver-transplanted group (0.11 ml/min) compared with the control group (0.20 ml/min). The relation between biliary clearance of PEG 900 and BSSR showed a significantly steeper slope for the cholecystectomized control patients (1.40 ml/micromol) compared with the liver-transplanted patients (0.30 ml/micromol). We conclude, that in spite of stable graft function with normal liver enzmyes, the transplanted liver has a reduced bile acid independent bile flow. The transplanted liver also has a reduced biliary clearance of PEG 900 indicating a reduced canalicular bile flow. The cause of this impaired bile formation could be due to the influence of the immunosuppressive drug cyclosporin, the result of damage to the liver during preservation and reperfusion or the continuous immunological challenge to the graft.
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