| 1. |
- Barkholt, L M, et al.
(författare)
-
Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis
- 1997
-
Ingår i: Transplant International. - : Frontiers Media SA. - 0934-0874 .- 1432-2277. ; 10:6, s. 432-438
-
Tidskriftsartikel (refereegranskat)abstract
- Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77%) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46% of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx (P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Jacobson, S H, et al.
(författare)
-
Renal fibrosis in cyclosporin A-treated renal allograft recipients : morphological findings in relation to renal hemodynamics
- 1996
-
Ingår i: Transplant International. - 0934-0874 .- 1432-2277. ; 9:5, s. 492-498
-
Tidskriftsartikel (refereegranskat)abstract
- Nineteen nondiabetic kidney graft patients treated with cyclosporin A for 2 years underwent percutaneous renal allograft biopsy as well as renal hemodynamic examination. Renal allograft fibrosis was quantitatively evaluated as the relative volume of the renal cortical interstitium (VV %) and as the interstitium/tubuli ratio (I/T ratio). The histological changes were then classified into four groups, depending on the degree of interstitial fibrosis. The glomerular filtration rate (GFR), renal plasma flow (RPF), renal blood flow (RBF), filtration fraction (FF), and fractional clearance of sodium, potassium, phosphate, chloride, osmoles, and free water clearance were determined in all patients and in 13 healthy controls. Kidney graft recipients had significantly lower GFR, lower RPF, and lower RBF than the healthy controls (P < 0.001 for all comparisons) while FF was similar in patients and controls. Transplant recipients had a significantly higher fractional excretion of sodium, potassium, chloride, and phosphate than controls. All except one patient had clearly increased VV values, indicating increased interstitial fibrosis. The mean VV in renal allograft patients was 35% ± 10% (normal < 16% ± 5%) and the I/T ratio was 1.07 ± 0.60 (normal < 0.24 ± 0.08). No correlation was found between the quantitative or semiquantitative biopsy analysis and any renal hemodynamic parameter measured. We conclude that renal function is significantly decreased in kidney graft recipients, but that adaptive tubular changes occur in the graft. Interstitial renal fibrosis was common but did not correlate to any renal functional parameter.
|
|
| 5. |
- Johnsson, C, et al.
(författare)
-
Hyaluronidase ameliorates rejection-induced edema.
- 1999
-
Ingår i: Transplant International. - 0934-0874 .- 1432-2277. ; 12:4, s. 235-43
-
Tidskriftsartikel (refereegranskat)abstract
- Hyaluronan, a glucosaminoglycan with unique water-binding capacity, is accumulated in the interstitial edematous tissue in rejecting organs. We here investigated whether the increased tissue content of water and hyaluronan seen during allograft rejection can be prevented by treatment with the hyaluronan-degrading enzyme hyaluronidase. Heterotopic heart transplantations between PVG and Wistar/Kyoto rats were performed. Recipient rats were treated with hyaluronidase prophylactically or therapeutically, either alone or in combination with cyclosporine. Daily intravenous injections of hyaluronidase induced a significant reduction of the cardiac content of both hyaluronan and water, as evaluated on day six after transplantation. Morphological examination revealed grafts with better preserved morphology and fewer infiltrating mononuclear cells, compared to untreated controls. Hyaluronidase therapy, alone or combined with cyclosporine, resulted in prolonged graft survival times. Hyaluronidase infusion for two hours also reduced already established edema five days after transplantation. This study confirms the hypothesis that hyaluronan accumulation plays a critical role in edema formation, and that hyaluronidase therapy can be used to reduce edema after organ transplantation.
|
|
| 6. |
- Lilja, Helene
(författare)
-
Hepatocyte Transplantation : book review
- 1999
-
Ingår i: Transplant International. - : Frontiers Media SA. - 0934-0874 .- 1432-2277. ; 12:6, s. 471-472
-
Recension (övrigt vetenskapligt/konstnärligt)
|
|
| 7. |
|
|
| 8. |
- Söderdahl, G, et al.
(författare)
-
Ursodeoxycholic acid increased bile flow and affects bile composition in the early postoperative phase following liver transplantation
- 1998
-
Ingår i: Transplant International. - : Frontiers Media SA. - 0934-0874 .- 1432-2277. ; 11:Suppl 1, s. S231-S238
-
Tidskriftsartikel (refereegranskat)abstract
- Orally given ursodeoxycholic acid (UDCA) has beneficial effects on laboratory parameters in different cholestatic conditions. In order to investigate the effect on early graft function after liver transplantation, 33 patients were randomized to receive either UDCA 15 mg/kg per day or placebo from the 1st postoperative day until 3 months after transplantation. All liver grafts produced bile within 24 h after revascularization. In both groups there was an increasing bile flow each day until day 5 after transplantation. This increase was more pronounced in the UDCA group where the flow on day 2 reached a mean value of 183 +/- 28 ml/day compared to 106 +/- 17 ml/day in the placebo group (P < 0.05). The average daily volume of bile produced during the first 10 days was also found to be higher in the UDCA group compared to the placebo group (242 +/- 20 ml vs 176 +/- 18 ml, P < 0.02). In the UDCA group a significant decrease in total bile acid output between the 5th and 10th postoperative days was found, while in the placebo group the amount of bile acids excreted remained stable over time. The composition of bile differed between the two groups with an increase in the portion of UDCA in the UDCA group from the 2nd postoperative day (25% vs 4.6%, P < 0.0003). The fraction of UDCA then remained high during the whole study period with a peak at day 3 when 38.1 +/- 6.6% of the bile acids consisted of UDCA. In the placebo group, the fraction of UDCA was low from the beginning and diminished further over time. Prophylactic UDCA treatment was found to have a significant positive impact on the ALT level during the 4th and 5th postoperative days, but had no effect on bilirubin or GGT in the early postoperative phase (days 1-10). No differences in cyclosporine requirement were found between the two groups.
|
|
| 9. |
- Ekberg, H, et al.
(författare)
-
Similar treatment success rate after renal transplantation in diabetic and nondiabetic patients due to improved short- and long-term diabetic patient survival
- 1996
-
Ingår i: Transplant international : official journal of the European Society for Organ Transplantation. - 0934-0874. ; 9:6, s. 64-557
-
Tidskriftsartikel (refereegranskat)abstract
- In the early era of transplantation, it was common practice to exclude diabetic patients since the outcome in such cases was usually poor. At our center in Malmö, Sweden, diabetic nephropathy was never regarded as a contraindication. During the 22-year period from 1972 to 1993, 223 renal allografts were transplanted in 189 uremic diabetics, representing 24% of all renal transplant recipients (n = 788). The two subgroups - patients with and without diabetes - did not differ significantly in graft survival rates for the 22-year period, which was characterized by a successive improvement in the success rate that was especially striking in the diabetic nephropathy subgroup. Among transplantations performed before 1988, the overall patient survival rate was significantly lower in the diabetic subgroup than in the remainder. After 1988 (when a series of new procedures had been adopted), the patient survival rate in the diabetic subgroup was similar to that in the nondiabetic subgroup, a similarity that persisted for at least 5 years. The 1st year post-transplant mortality rate was reduced in diabetic patients from 24% before 1988 to 0% in those transplanted after 1988. In the 22-year period as a whole, cardiovascular or cerebrovascular events were the most common cause of death in both subgroups; the risk of cardiovascular or cerebrovascular death was reduced after 1988, and the rates were similar in both subgroups. The improved success rate of renal transplantation in patients with diabetic nephropathy supports continuation of the renal transplant program, which is based on careful management of the early stages of the disease.
|
|
| 10. |
|
|
