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Clin Transpl. 1991;105-17.
Patient and primary graft survival for 2,090 patients who received primary liver transplants at the University of Pittsburgh from 1984 through 1990 are presented. Observed (actual) 3- and 12-month patient and primary graft survival rates were compared for 3 periods: 1) January 1984 to September 1987 (cyclosporine, OKT3, and Euro-Collins preservation period); 2) October 1987 to December 1988 (University of Wisconsin solution preservation period); and 3) January 1989 to December 1990 (FK506 period). Data for results according to age group, medical urgency, and primary diagnosis are provided. In addition, estimated survivor and cumulative hazard functions (life-table method) for patient and primary graft survival out to 60 months after transplantation are presented. Overall results have improved significantly in recent experience. Most notable are the improved results seen in liver transplantation for patients with biliary atresia (especially in infants), primary sclerosing cholangitis, fulminant hepatic failure, and chronic active hepatitis B. For all but a few conditions, most of the mortality after liver transplantation occurred in the first 3 months after surgery. Less than 2% of patients were lost in each 6-month interval beyond the first 6 months after transplantation. Outcome was related to patient condition at the time of surgery. Observed survival rates at 3 and 12 months for patients called in the hospital to receive a transplant were 88.6% and 86.5%, respectively, compared with 81.9% and 73.7% for patients in critical condition. The continuing shortage of organs for transplantation, which often forces patients to wait longer for an organ than they can afford to, continues to impose a significant penalty. |
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Transplant Proc. 1990 Oct;22(5):2224-5.
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Transplant Proc. 1990 Oct;22(5):2213-5.
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Transplant Proc. 1990 Oct;22(5):2183-4.
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Transplantation. 1990 Aug;50(2):230-3 doi: 10.1097/00007890-199008000-00011.
A prospective controlled study was carried out in 60 consecutive cadaver renal donors comparing cold storage to pulsatile machine-perfusion preservation. Each donor served as its own control, by allocating one of the kidneys to each of the two preservation methods. There were 51 evaluable pairs of kidneys. Recipient age, panel-reactive antibody level, history of prior renal transplant, and immunosuppressive regimen were similar in the two preservation groups. Almost all recipients were treated with cyclosporine, and over 50% received antilymphoblast globulin. Total cold ischemic time was 1262 +/- 387 min in the machine-perfused group and 1309 +/- 426 min in the cold-storage group (P = NS). Prolonged ischemia (greater than 24 hr) occurred in 31% of machine-perfused and 22% of cold-stored kidneys (P = NS). Post-operative serum creatinine levels at 1, 7, and 30 days posttransplant were similar in both groups. Dialysis requirements were also similar, with 21 recipients of machine-perfused kidneys (41%) requiring at least one dialysis treatment compared to 16 patients (31%) in the cold-stored group (P = NS); the mean number of dialysis treatments required was 3.14 +/- 1.46 and 3.06 +/- 1.29, respectively (P = NS). Long ischemic time (greater than 24 hr) was associated with a higher rate of dialysis requirement in both groups, but in neither case did this achieve statistical significance. The distribution of graft losses within the first 30 days was similar in both groups, and the incidence of preservation-related graft failure was not significantly different. These results demonstrate that, in the cyclosporine era, machine perfusion offers no significant advantages over cold storage for cadaver renal preservation. Because machine perfusion is considerably more expensive and cold storage is simpler and facilitates the logistics of organ sharing, we recommend simple hypothermic storage of renal allografts as the preservation method of choice. |
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Transpl Int. 1990 May;3(1):15-8 doi: 10.1007/BF00333196.
In order to examine renal function after brain death, twenty-eight patients were randomly separated into two groups. The systemic blood pressure of ten patients was maintained with epinephrine alone (group 1). Eight of the ten patients experienced cardiac arrest within 48 h (range 6-87 h) despite the rather large dosage of epinephrine. Urine output was uncontrollable and renal function deteriorated progressively in this group. Eighteen patients were maintained with arginine vasopressin and epinephrine (group 2). Circulation was maintained with a smaller dosage of epinephrine than that given group 1 for at least 4 days (mean +/- SD 16.5 +/- 12.2 days). Urine output was controlled within the normal range and serum levels of blood urea nitrogen (BUN) and creatinine were normal for 14 days. Daily creatinine clearance was more than 80 ml/min. The combined administration of arginine vasopressin and epinephrine preserved the kidneys after brain death for more than a week. This method will be of great value in renal transplantation from brain-dead organ donors. |
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Transplant Proc. 1990 Apr;22(2):448-9.
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Transplant Proc. 1990 Apr;22(2):390-1.
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Wien Klin Wochenschr. 1990 Mar 16;102(6):177-9.
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Transplantation. 1990 Feb;49(2):281-4 doi: 10.1097/00007890-199002000-00011.
This is a preliminary report of a European Multicenter Trial of the efficacy and safety of the UW solution in kidney preservation. The results obtained with the UW solution are compared with those obtained with Euro-Collins solution in a prospectively randomized study. To date 257 patients have been evaluated, with 128 receiving kidneys preserved in UW solutions and 129 receiving kidneys preserved in Euro-Collins solutions. Demographic characteristics of donors and recipients were identical in both groups. Median (and range) preservation times were similar (24 hr in EC and 24 hr in UW). Maximum preservation time in each group was about 48 hr. The results show that the UW solution is a safe preservation solution for kidneys, with postoperative renal functions, at least, equivalent to those seen in patients transplanted with kidneys preserved in EC solution. In this preliminary analysis of 257 kidneys, use of the UW solution resulted in a more rapid reduction in postoperative serum creatinine, higher creatinine clearance rate, and less postoperative dialysis (21% vs. 31%) when compared with kidneys preserved in EC solution. This study indicates that the UW solution is an effective preservation medium for clinical kidney transplantation. It supports the use of UW solution as a general flushout and cold storage solution for all intraabdominal organs used for transplantation. |