John Heil

Experimental and clinical experience with urine amylase monitoring for early diagnosis of rejection in pancreas transplantation

Pancreas allograft rejection in dogs with pancreati-cocystostomy can be predicted in advance of hyperglycemia by monitoring the urinary amylase (UA) concentration (U/L): In initial experiments, UA values declined to <1000 1.3±0.2 days before hyperglycemia in non-immunosuppressed dogs, 3.3±1.0 days in dogs treated with cyclosporine (CsA), and 9.3±0.7 days in dogs treated with CsA, azathioprine (Aza), and prednisone (triple therapy). Autotransplanted control dogs maintained high urine amylase concentrations indefinitely (mean 125,544±36,931). In a subsequent experiment, in 19 dogs with bladder-drained pancreas allografts on CsA only for prophylactic immunosuppression, a five-day course of antirejection treatment with Aza (5.0 mg/ kg) and antilymphocyte globulin ALG (1 mg/kg) was started in group A (n = 10) when a raise in serum glucose was detected, and in group B (n = 9) when a drop of UA below 1000 was observed. The functional allograft survival rate was 9.2±0.5 days in group A (treatment started after hyperglycemia) and 29.0±5.7 days in group B (treatment started after drop in UA) (P = .002). The UA dropped in all dogs before hyperglycemia, at a mean of 2.7 days in group A and 20.8 days in group B. Clinically, 8 patients received a whole cadaver pancreas transplant with urinary drainage of the exocrine secretions. All were followed with UA monitoring. Three recipients lost the grafts for technical reasons. One had a primary nonfunction and UA was below 1000 U/24 hr; two developed abscesses and the grafts were removed while functioning with high UA values. Five grafts are currently functioning; 3 recipients had no rejection episodes and their UA values ranged from 30,000 to 100,000 U/24 hr during their entire postoperative course. The other two had rejection episodes. In both cases UA decreased to baseline levels 1 and 4 days in advance of the hyperglycemia. After antirejection treatment UA rose again to high values and plasma glucose levels declined. Both patients are currently in.

The effects of delayed function on recipients of cadaver renal allografts: a study of 158 patients randomized to cyclosporine or ALG-azathioprine

We randomized 158 recipients of cadaver renal allografts to cyclosporine-prednisone (83) or antilymphocyte globulin-azathioprine-prednisone (75) to evaluate: (1) the effects of immunosuppression and pretransplant risk factors on the incidence of delayed graft function, (2) the effects of immunosuppression on the resolution of delayed graft function, and (3) the effects of delayed graft function and pretransplanted risk factors on patient and graft survival. Cyclosporine did not increase the incidence of delayed graft function, compared with ALG-azathioprine-treated patients (33% versus 27%, P=0.550) but doubled the mean (

Combined Immunosuppressive Therapy With Cyclosporin A And Azathioprine: A Synergistic Effect In Three Of Four Experimental Models

SD) duration of oil-guria (11.8

Renal preservation after warm ischemia using oxygen free radical scavengers to prevent reperfusion injury

11.0 versus 5.9

The pharmacokinetic advantage of local 6-mercaptopurine infusion in a canine renal transplant model

3.2 days, P=0.002) and the number of required dialyses (6.6

En bloc simultaneous pancreas and kidney allotransplantation in the pig

7.6 versus 3.2