The pediatric nephrologist's dilemma: Growth after renal transplantation and its interaction with age as a possible immunologic variable

Ettenger, Robert B.; Blifeld, Cindy; Prince, Harry E.; Gradus, D; Cho, Steve; Sekiya, Neil; Salusky, Isidro B.; Fine, Richard Ν.

doi:10.1016/s0022-3476(87)80049-5

Cited by 98 publications

(32 citation statements)

References 8 publications

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“…Since all organ transplantations require a long-term administration of these drugs, caution should be used when an organ has to be transplanted in a recipient who might suffer particularly from the effect of these drugs. An important example is found in children and adolescents who have to undergo isolated kidney transplantation (59,60). On the basis of our results the lowdose chronic immunosuppressive therapy does not appear to have a major effect on protein metabolism in IDDM patients or in patients with chronic uveitis.…”

Section: Discussionmentioning

confidence: 56%

“…In fact, also during combined hyperinsulinemia/hyperaminoacidemia, CU patients showed a normal stimulation ofprotein synthetic rate. To note that the results obtained in patients with chronic uveitis are also relevant for other organ transplantations, such as liver and heart, and indicate that the immunosuppressive therapy at the doses used after a transplant does not significantly affect wholebody protein homeostasis (59,60). A possible counteraction of hyperinsulinemia might explain the lack of deleterious effects of chronic immunosuppression in pancreas transplanted patients.…”

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

Combined pancreas and kidney transplantation normalizes protein metabolism in insulin-dependent diabetic-uremic patients.

Luzi¹,

Battezzati²,

Perseghin³

et al. 1994

J. Clin. Invest.

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In order to assess the combined and separate effects of pancreas and kidney transplant on whole-body protein metabolism, 9 insulin-dependent diabetic-uremic patients (IDDUP), 14 patients after combined kidney-pancreas transplantation (KPTx), and 6 insulin-dependent diabetic patients with isolated kidney transplant (K-Tx), were studied in the basal postabsorptive state and during euglycemic hyperinsulinemia (study 1). 11-14ClLeucine infusion and indirect calorimetry were utilized to assess leucine metabolism. The subjects were studied again with a combined infusion ofinsulin and amino acids, given to mimic postprandial amino acid levels (study 2). Amol* m-2. min-') (P = NS vs. CON). During hyperinsulinemia (study 1), IDDUP showed a defective decrease of leucine (42% vs. 53%; P < 0.05), BCAA (38% vs. 47%, P < 0.05), ELF (28% vs. 33%, P < 0.05), and LO (0% vs. 32%, P < 0.05) with respect to CON. Isolated kidney transplant reverted the defective inhibition of ELF (34%, P = NS vs. CON) of IDDUP, but not the inhibition of LO (18%, P < 0.05 vs. CON) by insulin. Combined kidney and pancreas transplantation normalized all kinetic parameters of insulin-mediated protein turnover. During combined hyperinsulinemia and hyperaminoacidemia (study 2), IDDUP showed a defective stimulation of NOLD

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 94%

Combined pancreas and kidney transplantation normalizes protein metabolism in insulin-dependent diabetic-uremic patients.

Luzi¹,

Battezzati²,

Perseghin³

et al. 1994

J. Clin. Invest.

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“…In the past, young kidney recipients have been considered high risk, with diminished graft survival compared with older children and adults (6,7). In many reports, the worst survivals were seen in the youngest patients.…”

Section: Kidney Transplantationmentioning

confidence: 99%

Pediatric transplantation

Magee

Bucuvalas

Farmer

et al. 2004

American Journal of Transplantation

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“…This was attributed to an increased immunologic responsiveness in young children [6,7]. Altogether, the rejection rates in children have markedly decreased (as seen in adults) during the last decades from 70 % before 1990 to 13 % in the most recent observation period [1].…”

Section: Introductionmentioning

confidence: 99%

Histopathological diagnosis of acute and chronic rejection in pediatric kidney transplantation

Bröcker

Mengel

2013

Pediatr Nephrol

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ABO-compatible as well as ABO-incompatible kidney transplantation are well established in the pediatric population. There are particularities in the histopathological evaluation of pediatric kidney transplant biopsies as for example the recurrence of certain diseases different from the adult population. Furthermore, the challenging transition of pediatric renal transplant recipients to adulthood is associated with an increased rate of non-adherence triggered rejection episodes. With modern immunosuppressive drugs, T-cellmediated rejection of renal allografts is well controlled. In contrast, antibody-mediated rejection (AMR) is increasingly recognized as one of the major reasons for allograft loss. However, the 2001 diagnostic Banff criteria for antibodymediated rejection require further refinement, as the morphological spectrum of AMR expands while effective therapeutic strategies are lacking. For example, endarteritis, which traditionally has been attributed to T-cell-mediated rejection, has recently been shown to be part of the AMR spectrum in some cases. Many findings in transplant renal biopsies are not specific for a certain disease but need consideration of differential diagnoses. To use the term "chronic allograft nephropathy" as a diagnostic entity is no longer appropriate. Therefore, the precise identification of specific diseases is paramount in the assessment of transplant renal biopsies in order to enable tailored therapeutic management.

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The pediatric nephrologist's dilemma: Growth after renal transplantation and its interaction with age as a possible immunologic variable

Cited by 98 publications

References 8 publications

Combined pancreas and kidney transplantation normalizes protein metabolism in insulin-dependent diabetic-uremic patients.

Combined pancreas and kidney transplantation normalizes protein metabolism in insulin-dependent diabetic-uremic patients.

Pediatric transplantation

Histopathological diagnosis of acute and chronic rejection in pediatric kidney transplantation

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