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  • 1
    ISSN: 1433-0563
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1433-0563
    Keywords: Key words Organ procurement • Organ preservation • Kidney transplantation • Donor kidney evaluation ; Schlüsselwörter Organentnahme • Organkonservierung • Nierentransplantation • Spendernierenbeurteilung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Organspendeoperation beim hirntoten Spender wird heute in der Regel als Multiorganentnahme (MOE) geplant. Neben den Nieren werden dann meist Herz und Leber, seltener auch Lungen und Pankreas entnommen. Dazu ist eine gut Synchronisation der verschiedenen Entnahmeteams (Thorax-, Abdominalchirurgen, Urologen) notwendig, damit kein für eine Transplantation vorgesehenes Organ aus technischen Gründen verloren geht. Über 40 % der Nierentransplantationen in der BRD erfolgen durch Urologen. Diese Kliniken führen bei der Organgewinnung die alleinigen Nierenentnahmen durch und sind auch an der MOE beteiligt. Die Beteiligung eines transplantationserfahrenen Urologen an der MOE erscheint aus verschiedenen Gründen sinnvoll. Im Bremer Transplantationszentrum gingen seit 1987 390 Spendermeldungen ein, 202 Organspendeoperationen wurden durchgeführt, davon 106 MOE und 96 alleinige Nierenentnahmen. Von 398 gewonnenen Nieren wurden 382 transplantiert.
    Notes: Summary Today the organ donor operation in brain dead donors is mostly projected as multiple organ procurement (MOP). Not only the kidneys, but heart and liver or additionally lungs and pancreas are removed in MOP. A good synchronization between the collaborating transplantation groups (thoracic and abdominal surgeon, urologist) is essential to prevent loss of an organ because of technical problems. In Germany urologists perform more than 40 % of kidney transplantations. These urologic institutions perform the cadaver kidney retrievals and participate on MOP. If possible, an urologist experienced in renal transplantation should contribute to the care for quality of the kidneys. Since 1987 the transplant center of Bremen obtained 390 donor registrations. 202 organ donor operations have been performed (106 MOP and 96 exclusive kidney retrievals). 398 donor kidneys have been collected and 382 could be transplanted.
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  • 3
    ISSN: 1432-2277
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1434-0879
    Keywords: Alloplastic urethral replacement ; Urethral substitution
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In 12 male dogs 3–8 cm of the penile urethra were resected and replaced by expanded polytetrafluoroethylene (GORE-TEX®) grafts. Follow-up consisted of periodic urethrograms. Maximum observation time has been 12 months. Up to now, no major complications were noted. Tissue reactions were minimal and patency of all grafts was demonstrated during the follow-up period.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    World journal of urology 6 (1988), S. 70-74 
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Adequate pretreatment and proper donor nephrectomy are important prerequisites for successful renal transplantation with considerable impact on initial renal function and potential postoperative surgical and urological complications. The physiological function of the donor kidneys must be maintained until devascularization. The technique of donor nephrectomy should guarantee minimal warm ischemia and preservation of the renal and ureteral vascular supply. Moreover, this procedure should be standardized, as it is also easily applicable by nontransplant surgeons and urologists in hospitals procuring donor kidneys for transplant centers.
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  • 6
    ISSN: 1433-8726
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A total of 385 patients (83% men, 52% aged 16–30) with urogenital (UG) trauma were treated in 19 urological clinics between April 1984 and December 1986. In all, 41% of the accidents were due to traffic; 13% to work and sports each; 8% to sexual activities; and 6% to violence. The distribution of injury severity included 40% light, 21% moderate and 39% severe. Of 427 UG lesions, 27% were combined with intraabdominal and 24% with pelvic injuries. The kidneys were involved in 51% of cases and the bladder, urethra, penis and scrotum, including its content, in ca. 10% each. Of the renal traumas, 49% were ruptures; 48% contusions; and 7% hilar lesions,a nd in 6% the complete destruction of the organ occurred. In all, 76% of these traumas were treated conservatively, whereas 8% each required reconstruction or nephrectomy. Amongst the urethral ruptures, 46% were complete; 39% partial posterior; and 11% ruptures of the penile urethra. In 43% of cases the treatment was conservative and in 41% a primary reconstruction was carried out. All intraperitoneal (43%) and 2/3 of the extraperitoneal bladder ruptures (57%) were operated on. Gross hematuria was found in 73% of the renal, 83% of the vesical and 73% of the urethral injuries. Microhematuria occurred in 24%, 9% and 13% of cases, whereas no hematuria was found in 3%, 5% and 13% of the kidney, bladder and urethral injuries, respectively. The injury-relevant sensitivity of the imaging methods was computed to be 95% for cystograms, 91% for urethrograms and 83% for angiograms. When used to screen trauma patients, the sensitivity proved to be 69% for the CT scan, 55% for the intravenous pyelogram (IVP) and 54% for sonography. Overall, 37% of 161 complications involved the UG tract, followed by neurological complications, those due to the operation or treatment, to infections or to organ failure. In all, 11% of patients remained in the hospital for only 1 day; 50% for up to 13 days; 20% for 14–60 days; and 17% for 〉60 days.
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  • 7
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Cryobiology 11 (1974), S. 571 
    ISSN: 0011-2240
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Medicine
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  • 8
    ISSN: 1432-1440
    Keywords: Kidney transplantation ; Rejection reaction ; Immune mechanisms ; Nierentransplantation ; Abstoßungsreaktion ; Immunmechanismen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der Erfolg einer Nierentransplantation ist heute weitgehend von immunologischen Faktoren abhängig. Obwohl die Ergebnisse der klinischen Transplantation in den letzten Jahren zunehmend verbessert werden konnten, kommt es immer noch relativ häufig zur Abstoßung von Transplantaten. Das Schicksal eines Transplantats wird in erster Linie durch Unterschiede in den Histokompatibilitäts-Antigenen zwischen Spender und Empfänger bestimmt, die für die Stärke der immunologischen Reaktion verantwortlich sind. Nach der Transplantation kommt es im Empfänger zur Aktivierung von T- und B-Lymphozyten. Aus einer Subpopulation sensibilisierter T-Lymphozyten werden in Kooperation mit einer weiteren Subpopulation von T-Lymphozyten, den T-Helfer-Zellen, zytotoxische Effektorzellen generiert. Außerdem werden im Verlauf einer Abstoßungsreaktion Verstärkermechanismen der zellulären und humoralen Immunität ausgelöst. Von sensibilisierten Lymphozyten können Mediatoren sezerniert werden, die unspezifische Effektorzellen wie Monozyten, Granulozyten und Lymphozyten im Transplantat konzentrieren und zu ihrer Funktion aktivieren. Die Aktivierung von B-Lymphozyten führt zur Ausreifung Antikörper-sezernierender Plasmazellen. Antikörper können unter Komplementbeteiligung eine zytotoxische Schädigung des Transplantats verursachen oder Zellen zur sog. Antikörper-abhängigen Zytotoxizität befähigen. Andererseits können blockierende Antikörper, Immunkomplexe oder auch Suppressor-Lymphozyten einen protektiven Einfluß auf das Transplantat haben. Ziel dieser Arbeit ist es somit, diese vielfältigen Mechanismen, ihre Interaktion sowie Bedeutung für die klinische Nierentransplantation darzustellen. Es ist zu erwarten, daß das wachsende Verständnis in die Vorgänge bei der Abstoßungsreaktion das diagnostische und therapeutische Vorgehen beeinflußen wird und somit die Ergebnisse der Nierentransplantation in Zukunft verbessert werden können.
    Notes: Summary Today, the success of kidney transplantation largely depends upon immunological factors. Despite the fact that the results of clinical transplantation have continuously improved within the last years, graft rejection is still a relatively frequent event. The fate of a transplant is primarily dependent upon differences in the histocompatibility antigens between donor and recipient. These differences are responsible for the intensity of the immunological reaction. After transplantation there is an activation of T- and B-lymphocytes in the recipient. In cooperation with a subpopulation of T-lymphocytes, the T-helper cells, cytotoxic effector cells are generated from a further subpopulation of T-lymphocytes. In addition, amplifier mechanisms of cellular and humoral immunity are activated in the course of a rejection reaction. Sensitized lymphocytes may secrete mediators which concentrate the non-spezific cells such as monocytes, granulocytes and lymphocytes in the transplant and lead to the functional activation of these effector cells. The activation of B-lymphocytes leads to maturation of antibody secreting plasma cells. Antibodies cause cytotoxic damage to the transplant, either with involvement of the complement system or through cells which produce antibody-dependent cytotoxicity. On the other hand, blocking antibodies, immune complexes or suppressor lymphocytes may have a protective effect on the transplant. The aim of this paper is to describe the present state of knowledge of these diverse mechanisms, their mutual interactions as well as their relevance for clinical transplantation. It is expected that a better understanding of the immune reactions involved will influence the diagnostic as well as the therapeutic procedures used in patients with graft rejection, thus leading to better results for kidney transplantation in the future.
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  • 9
    ISSN: 1432-1440
    Keywords: MHC ; Cadaver kidney transplantation ; Graft survival rate ; Blood transfusions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The influence of prospective HLA-DR matching on the graft survival rate was investigated in a multicenter analysis of 85 transplants. Simultaneously in a retrospective analysis of graft outcome the importance of matching for MT-antigens MT1, MT2 and MT3 as a newly defined B-cell alloantigen system was evaluated. HLA-DR antigens and MT-specificities were determined on B-cells enriched by nylon-wool filtration using locally well characterised HLA-DR antisera and the antiserum set of the 8th International Histocompatibility Workshop (“discase set”) which allowed the definition of the HLA-DR specificities HLA-DR 1–9 and of the MT-antigens MT 1–3. HLA-DR matching showed a significantly improved graft outcome only in HLA-DR identical donor-recipient combinations. In 11 of 60 patients with one HLA-DR compatibility additional matching for two MT-antigens, however, improved the two year graft survival rate from 60% to 91%. Altogether 17 patients were matched for two MT-specificities with their kidney donor and showed a superior prognosis of 94% at two years compared to 53% or 17% of recipients with one or zero MT compatibility. Graft outcome in this patient group was also superior to that of HLA-DR identical or HLA-AB identical grafts. These data suggested that the MT-system rather than the HLA-DR antigens may be of critical importance in cadaver kidney transplantation. In addition a favorable influence of pretransplant blood transfusions on less HLA-DR matched grafts was confirmed.
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  • 10
    ISSN: 1432-1440
    Keywords: Renal transplantation ; Steroid osteoporosis ; 1,25-Dihydroxy vitamin D3 ; Immunosuppressive therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Forearm bone mineral content (BMC), as evaluated by photonabsorption densitometry, was measured in 28 cadaver kidney donor recipients who entered the study 8 weeks postoperatively and were followed up for 18 months. BMC decreased signifiantly (p〈0.05) but marginally in placebo-treated patients (n=14) (initial BMC 1.09±0.25 g/cm; final BMC 1.05±0.24). Fourteen patients were prophylactically given 1,25(OH)2vitamin D3 in a dose which avoided hypercalcemia and hypercalciuria (∼0.25 µg/day); under 1,25(OH)2 vitamin D3 prophylaxis a significant decrease of forearm BMC was observed no longer (initial BMC 0.94±0.21 g/cm; final BMC 0.95±0.21), but the difference between placebo and 1,25(OH)2 vitamin D3 narrowly missed statistical significance (p=0.066). It is concluded that the decrease of forearm BMC is negligible in transplant recipients with low steroid regimens. The data suggest a trend for prophylaxis with 1,25(OH)2 vitamin D3 to slightly ameliorate forearm (cortical) BMC loss.
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