Pediatricians
30 years of experience
Video profile
Accepting new patients
Providence Alaska Medical Center
3300 Providence Dr
Ste 212
Anchorage, AK 99508
907-561-4459
Locations and availability (1)

Education ?

Medical School Score Rankings
University of Washington (1980)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
Patients' Choice 5th Anniversary Award (2012)
Patients' Choice Award (2008 - 2012)
Compassionate Doctor Recognition (2010 - 2012)
Associations
American Board of Pediatrics

Affiliations ?

Dr. Briggs is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Providence Alaska Medical Center
    PO Box 196604, Anchorage, AK 99519
    • Currently 1 of 4 crosses
  • Alaska Regional Hospital
    2801 Debarr Rd, Anchorage, AK 99508
    • Currently 1 of 4 crosses
  • Providence Extended Care Center
    4900 Eagle St, Anchorage, AK 99503
  • Publications & Research

    Dr. Briggs has contributed to 55 publications.
    Title Management of Cytomegalovirus Infection by Weekly Surveillance After Renal Transplant: Analysis of Cost, Rejection and Renal Function.
    Date February 2004
    Journal Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
    Excerpt

    BACKGROUND: Recently published guidelines recommend anti-viral prophylaxis as the best method of preventing cytomegalovirus (CMV) disease in the post-transplant period, but some authors have suggested that surveillance strategies may be as effective and less costly. The aim of the present study was to analyse the effectiveness and cost of a deferred treatment strategy using weekly CMV polymerase chain reaction (PCR) surveillance in high risk renal transplant recipients. METHODS: We used weekly surveillance for plasma CMV PCR positivity for the first 3 months in consecutive renal transplants between CMV seropositive donors and seronegative recipients, and analysed incidence of CMV infection, timing of infection, acute rejection and renal function at 1 year. RESULTS: There was evidence of CMV infection in 27/41 (65.9%) patients and of CMV disease in 20/41 (48.8%). Only 8/20 (40%) patients were PCR positive before disease onset. Patients were treated on the basis of clinical evidence of CMV disease (deferred strategy), but we used the data to compare the potential costs of a pre-emptive strategy (all patients PCR positive before the onset of clinical features of disease treated with intravenous ganciclovir) and prophylaxis (oral ganciclovir for 3 months in all patients). The deferred strategy cost pound 1159 per patient (excluding the cost of hospitalization) while a pre-emptive strategy would cost pound 1381 per patient. Prophylaxis costs pound 1500- pound 2213 per patient depending on published estimates of relative risk reduction. Mean estimated creatinine clearance at 1 year was 70.0 ml/min in patients who experienced no infection, 47.7 ml/min in patients who experienced infection but no disease, and 39.6 ml/min in patients who experienced CMV disease (P < 0.001). The incidence of acute rejection in these groups was 7.1, 14.3 and 35%, respectively (P = 0.13). CONCLUSIONS: CMV surveillance strategies may cost slightly less but may have a deleterious effect on long-term outcome compared with prophylaxis.

    Title Biocompatible Membranes Do Not Promote Graft Recovery Following Cadaveric Renal Transplantation.
    Date September 2002
    Journal Clinical Nephrology
    Excerpt

    Controversy surrounds the role of biocompatible membrane dialyzers in treatment of acute renal failure. Studies that have shown a benefit have involved critically ill patients where renal recovery and patient mortality are influenced by other comorbid disease. The aim of the present work is to clarify this issue in a more homogeneous population of patients with acute renal failure following cadaveric renal transplantation.

    Title The Impact of Late Acute Rejection After Cadaveric Kidney Transplantation.
    Date December 2001
    Journal Clinical Transplantation
    Excerpt

    BACKGROUND: Acute graft rejection (AR) following renal transplantation results in reduced graft survival. However, there is uncertainty regarding the definition, aetiology and long-term graft and patient outcome of AR occurring late in the post-transplant period. AIM: To determine if rejection episodes can be classified by time from transplantation by their impact on graft survival into early acute rejection (EAR) and late acute rejection (LAR). MATERIALS AND METHODS: 687 consecutive adult renal transplant recipients who received their first cadaveric renal transplant at a single centre. All received cyclosporine (CyA)-based immunosuppression, from 1984 to 1996, with a median follow-up of 6.9 yr. Details were abstracted from clinical records, with emphasis on age, sex, co-morbid conditions, HLA matching, rejection episodes, patient and graft survival. ANALYSIS: Patients were classified by the presence and time to AR from the date of transplantation. Using those patients who had no AR (NAR) as a baseline, we determined the relative risk of graft failure by time to rejection. The characteristics of patients who had no rejection, EAR and LAR were compared. RESULTS: Compared with NAR, the risk of graft failure was higher for those patients who suffered a rejection episode. A much higher risk of graft failure was seen when the first rejection episode occurred after 90 d. Thus, a period of 90 d was taken to separate EAR and LAR (relative risk of 3.06 and 5.27 compared with NAR as baseline, p<0.001). Seventy-eight patients (11.4%) had LAR, 271 (39.4%) had EAR and 338 (49.2%) had NAR. The mean age for each of these groups differed (LAR 39.6 yr, EAR 40.8 yr compared with NAR 44 yr, p<0.003). The 5-yr graft survival for those who had LAR was 45% and 10-yr survival was 28%. HLA mismatches were more frequent in those with EAR vs. NAR (zero mismatches in HLA-A: 36 vs. 24%, HLA-B: 35 vs. 23% and HLA-DR: 63 vs. 41%, p<0.003). There was no difference in mismatching frequency between NAR and LAR. CONCLUSIONS: AR had a deleterious impact on graft survival, particularly if occurring after 90 d. AR episodes should therefore be divided into early and late phases. In view of the very poor graft survival associated with LAR, it is important to gain further insight into the main aetiological factors. Those such as suboptimal CyA blood levels and non-compliance with medication should be further investigated with the aim of developing more effective immunosuppressive regimens in order to reduce the incidence of LAR.

    Title Renal Transplantation in the Uk and Republic of Ireland.
    Date September 2001
    Journal Clinical Transplants
    Excerpt

    RENAL TRANSPLANT OUTCOME: Analysis of 5-year transplant survival in the UK showed a number of significant factors influencing outcome of adult cadaveric renal transplantation. Data from 5,963 first grafts and 1,078 regrafts carried out between 1990-1997 showed year of graft, recipient age and diabetes, donor age, kidney exchange between centres and HLA matching to influence 5-year outcome. The most important prognostic factor was donor age: the risk of transplant failure within 5 years for grafts using kidneys from donors aged 60 years and over was double that of grafts using donors aged 18-34 years. Unlike the effect of donor age, the influence of HLA matching would appear to be diminishing with time. In contrast to transplants in the 1980's, the difference in 5-year transplant survival between 000 mismatched and favourably matched (100, 010 or 110 mismatched) transplants is no longer significant. An analysis of posttransplant survival for first grafts in different epochs (0-3 months, 3 months to 3 years and beyond 3 years) showed that one factor affected short-term outcome (exchange of kidneys between centres), whereas others affected outcome throughout the epochs (most notably donor age, recipient age and recipient diabetes). RECIPIENT AND DONOR AGE MATCHING: The mean recipient age in the UK and Republic of Ireland increased by 5 years between 1981-1990 but has remained at approximately 45 years since then. The mean donor age increased by 7 years to 42.5 years (s.e. 0.5) between 1981-1991 and since then has increased at a slower rate to 43.4 years (s.e. 0.5) in 1998. The mean donor-recipient age difference for more than 15,000 transplants carried out between 1990-1998 has decreased, primarily due to increasing donor age over this time. However, the introduction of a new Kidney Allocation Scheme in the UK in July 1998, part of which is aimed at minimising age differences, has increased the likelihood that recipients aged over 60 years will be allocated grafts from donors closer to their own age than previously. The new UK Kidney Allocation Scheme also gave children increased access to well-matched adult organs leading to an increased mean age difference for this group between July-December 1998. DONOR AND RECIPIENT HLA MATCHING: Modifications to the Kidney Allocation Scheme introduced in January 1997 with the aim of increasing the number of well-matched transplants has led to a rise in 000 mismatched grafts from 5% to 7% and favourably matched (100/010/110 mismatches) from 29% to 36% between 1990-1992 and 1996-1998. Over this same time the proportion of 2 DR-mismatched grafts has decreased from 10% to 4%. The revised Kidney Allocation Scheme implemented in July 1998 gave a further increase in priority to 000 mismatches, increasing the proportion of these transplants to 12% for the last half of 1998, a level which has been maintained since then.

    Title Analysis of Factors That Affect Outcome of Primary Cadaveric Renal Transplantation in the Uk. Hla Task Force of the Kidney Advisory Group of the United Kingdom Transplant Support Service Authority (uktssa)
    Date October 1999
    Journal Lancet
    Excerpt

    BACKGROUND: In the UK, kidneys are exchanged between centres on the basis of matching for HLA. We analysed various factors that might affect graft outcome to establish whether exchange of kidneys on this basis remains valid. METHODS: 6363 primary cadaveric renal transplants carried out in 23 centres in the UK between 1986 and 1993 were used in the analysis. 6338 (99.6%) patients who underwent transplantation were followed up at 1 year. 5-year follow-up data were available for 2907 (97.8%) of the 2972 patients who survived to 5 years. We made random checks to validate the data. A multifactorial analysis with Cox's proportional hazards models was used to analyse factors that had a possible effect on graft outcome. To ensure that the analysis of matching was constant during the 8-year study, our analysis was based on the HLA antigens used for organ exchange (11 A locus antigens, 27 B locus antigens, and 12 DR locus antigens). We assessed overall outcome at 5 years and during three periods after transplantation at: 0-3 months, 3-36 months, and after 36 months. FINDINGS: The following factors were significantly associated with graft outcome in the multifactorial analysis: year of graft, age of donor, age of recipient, whether the recipient had diabetes, cause of donor's death, cold ischaemic time, transport of kidneys, transplant centre, and matching for HLA. The best outcome was achieved with kidneys that had no mismatches at HLA-A, HLA-B, and HLA-DR loci (000 mismatches). The next most favourable outcome was achieved with one mismatch at either A or B loci or one mismatch at both the A and B , but no mismatch at the DR locus (100, 010, or 110 mismatches). Age of the donor and recipient had a significant effect on transplant outcome: older age was associated with increased risk of graft failure. INTERPRETATION: Various factors affect the outcome of primary cadaveric renal transplantation, particularly the age of the donor and the recipient. However, the effect of matching for HLA remains a strong one and fully justifies the continuing policy in the UK of exchanging kidneys on the basis of HLA matching, especially to recipients when there is a 000 mismatch for HLA between donor and recipient. On the basis of this analysis, a new allocation scheme for kidneys was introduced in the UK in 1998. During the first 9 months of the scheme, there has been a doubling of the number of HLA-000 mismatched kidneys transplanted.

    Title Early Graft Function and Patient Survival Following Cadaveric Renal Transplantation.
    Date April 1999
    Journal Kidney International
    Excerpt

    The influence of events that occur early following renal transplantation such as delayed graft function (DGF) and acute rejection on long-term graft survival has been widely reported, but its association with patient survival has received less attention.

    Title Longitudinal Evaluation of Peritoneal Macrophage Function and Activation During Capd: Maturity, Cytokine Synthesis and Arachidonic Acid Metabolism.
    Date November 1996
    Journal Kidney International
    Excerpt

    The release of cytokines and prostaglandins (PG) by peritoneal macrophages (PM luminal diameter of) may influence the cytokine network controlling peritoneal inflammation and in the long-term the function of the peritoneum as a dialysis membrane. In the present study, an evaluation of the long-term effects of peritoneal dialysis on the release of cytokines and prostaglandins, and the expression of surface markers of cellular maturation on blood and mononuclear cells has been performed in patients during their first year on CAPD. Spontaneous release of tumour necrosis factor alpha (TNF alpha) and interleukins 6 (IL-6) by PM luminal diameter of, after 4 or 24 hours in culture, increased significantly with time on CAPD, while there was a small but significant decrease in release of prostaglandin E2 (PGE2). Production of TNF alpha and IL-6 was enhanced following incubation of the cells with lipopolysaccharide (LPS), but the effect of LPS was proportionally greater on blood monocytes than on PM luminal diameter of. There was a significant increase in the concentrations of PGE2 and 6-keto-prostaglandin F1 alpha in overnight dwell peritoneal dialysis effluent with time on CAPD. The levels of TNF alpha and IL-6 in uninfected PDE were below the detection limit of the immunoassay over the whole time period studied. Expression of CD15, which correlates with immaturity, by PM luminal diameter of and blood monocytes increased with time on CAPD, while expression of CD11c, a marker of maturation, decreased on blood monocytes, but did not change significantly on PM luminal diameter of. There was also a slight increase in expression of transferrin receptor in both PM luminal diameter of and monocytes, but this did not reach statistical significance. These findings suggest that peritoneal macrophages and blood monocytes isolated from CAPD patients over a one year period become increasingly immature with time, and this is accompanied by a significant modulation of their ability to secrete inflammatory cytokines. Dysregulation of macrophage function may have important consequences with respect to inflammatory processes and the long-term function of the peritoneal membrane in CAPD patients.

    Title Patient-to-patient Transmission of Hepatitis C Virus.
    Date June 1995
    Journal Lancet
    Title Long-term Outcome of the Use of Okt3 to Treat Steroid-resistant Acute Renal Allograft Rejection.
    Date November 1994
    Journal Transplant International : Official Journal of the European Society for Organ Transplantation
    Excerpt

    OKT3 was used to treat steroid-resistant acute renal allograft rejection in 30 of 496 adult patients transplanted over a 6-year period. Rejection was reversed (defined as a fall in serum creatinine by 50% or more within 30 days of treatment with OKT3) in 40% of cases. Successful reversal was significantly more likely when rejection occurred shortly after transplantation (t ratio -2.53; P = 0.019). The long-term outcome was disappointing; the actuarial graft survival at 1 year from the start of treatment with OKT3 was 42%, and no grafts have thus far survived longer than 3 years. Graft survival was shorter in older patients (coefficient/standard error 2.226; P < 0.05), and no other predictor of long-term outcome was identified. Patient survival at 3 years was 88%. Serious infection occurred in 33% of patients, with two deaths. Our experience suggests that treatment with OKT3 is unlikely to reverse acute renal allograft rejection in more than half of patients where rejection is resistant to steroids. Although long-term graft survival occurred in a few cases, the overall long-term outcome was disappointing, particularly in older patients. Finally, our analysis indicates the difficulty of predicting which patients will derive long-term benefit when OKT3 is used to treat steroid-resistant rejection.

    Title Adhesion Molecule Expression (icam-1, Vcam-1, E-selectin and Pecam) in Human Kidney Allografts.
    Date October 1994
    Journal Transplant Immunology
    Excerpt

    Expression of the cellular adhesion molecules ICAM-1, VCAM-1, E-selectin and PECAM in human kidney allografts was assessed by immunoperoxidase labelling of cryostat sections. Biopsies from 10 kidneys immediately prior to transplantation and 58 biopsies from 51 kidney transplants with graft dysfunction were studied. Allograft dysfunction was due to acute tubular necrosis (n = 5), acute rejection (n = 30), cyclosporin A (CyA) nephrotoxicity (n = 6), acute pyelonephritis (n = 3), recurrent glomerulonephritis (n = 4) and chronic rejection (n = 10). There was variability in the distribution of ICAM-1, VCAM-1 and E-selectin expression in pretransplant kidneys but the principal observation was a marked increase in the expression of ICAM-1 and VCAM-1 by the renal vasculature and the proximal tubules during acute rejection. By contrast, grafts with dysfunction not attributed to rejection showed a pattern of ICAM-1 and VCAM-1 expression similar to that observed prior to transplantation. E-selectin was expressed only weakly by occasional intertubular capillaries during acute rejection but the three grafts with pyelonephritis displayed strong expression of E-selectin on intertubular capillaries. There was no change in the pattern of PECAM expression following transplantation. The induction of ICAM-1 and VCAM-1 during rejection may contribute to the recruitment of mononuclear cells and render endothelial and tubular renal cells more susceptible to cell-mediated injury.

    Title Hepatitis C Virus Infection Detected by Antibody Tests and the Polymerase Chain Reaction As a Cause of Liver Dysfunction in Renal Transplant Recipients.
    Date May 1994
    Journal Journal of Medical Virology
    Excerpt

    Hepatitis C infection (HCV) is more prevalent in patients who have received kidney transplants than in the general population but the morbidity and mortality associated with infection in this group is unclear. Sera taken from 36 renal transplant recipients with chronic liver dysfunction and from 42 with normal liver function were tested for HCV infection by second generation ELISA (Abbott Laboratories) and second generation recombinant immunoblot assay (Chiron Corporation) (RIBA-2). Evidence of HCV replication was sought by reverse transcription polymerase chain reaction (RT PCR) using primers from the 5' nontranslated region (5'NTR). Infection was detected in 20/36 (54%) and in 2/42 (4.8%) controls (P < 0.01). Twelve liver dysfunction patients were positive by all three tests, six were positive by ELISA and RT PCR but had indeterminate RIBA-2, one was positive by ELISA and RIBA but negative by RT PCR, and one was positive only by RT PCR. Of two infected control patients, one was positive by all three tests and one who was later found to have been in the early stage of infection was positive only by RT PCR. Follow-up of infected patients showed persistence of viraemia in 14/15 (93%). Evidence of infection with different types of HCV was shown by the lack of amplification by RT PCR by primers with mismatching bases with HCV types 2 and 3. It is concluded that in our renal transplant patients, chronic HCV infection is usually associated with liver dysfunction and persistent infection is common.

    Title The Spectrum of Chronic Liver Disease in Renal Transplant Recipients.
    Date November 1992
    Journal The Quarterly Journal of Medicine
    Excerpt

    Chronic liver disease has been reported to be an important cause of late morbidity and mortality in renal transplant recipients. We have examined the prevalence and nature of chronic liver disease among 538 patients with functioning renal allografts managed at the Western Infirmary, Glasgow, between 1980 and 1989. Thirty-seven patients (7 per cent) satisfied biochemical criteria for chronic liver dysfunction. Liver biopsies were obtained from 24 of these, and autopsy tissue was available from three other patients. Chronic hepatitis of variable severity was present in 15 patients, haemosiderosis in 12 patients and nodular regenerative hyperplasia in five patients. Nineteen patients (51 per cent) had serological evidence of infection with the hepatitis C virus, and one of these developed chronic hepatitis B and D infection as well. Although a variety of chronic liver diseases occurred in our transplant population, the frequency of serious sequelae from liver dysfunction was much lower than that reported from transplant centres in other countries.

    Title Consensus on General Medical Contraindications to Organ Donation?
    Date November 1992
    Journal Bmj (clinical Research Ed.)
    Title Expression of Transferrin Receptors by Monocytes and Peritoneal Macrophages from Renal Failure Patients Treated by Continuous Ambulatory Peritoneal Dialysis (capd).
    Date March 1992
    Journal European Journal of Clinical Investigation
    Excerpt

    Approximately 20% of monocytes and peritoneal macrophages from renal failure patients undergoing continuous ambulatory peritoneal dialysis (CAPD) were transferrin-receptor (TfR) positive by immunofluorescence, whereas cells from normal controls were generally TfR negative, as were monocytes from rheumatoid arthritis patients and from renal failure patients treated by haemodialysis. There was a significant correlation between the length of time on CAPD and the proportion of TfR-positive blood monocytes. CAPD peritoneal macrophages possessed 6.7-37.1 x 10(3) transferrin binding sites per cell, with a Ka of 3-25 x 10(7) mol l-1. In culture, monocytes from CAPD patients showed a progressive decrease in TfR expression, while in contrast about 20% of monocytes from normal controls which were originally 100% TfR negative expressed TfR after 3 days in culture. These findings indicate that regulation of TfR in monocytes/macrophages is complex, and that frequent removal of peritoneal cells during dialysate exchange may place a strain on the bone marrow, resulting in the release of an increasingly immature population of TfR positive monocytes to the circulation in CAPD patients.

    Title Longitudinal Study of Peritoneal Defence Mechanisms in Patients on Continuous Ambulatory Peritoneal Dialysis (capd).
    Date April 1991
    Journal Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
    Excerpt

    Peritoneal cellular and humoral defence mechanisms have been examined in a group of 16 patients over a nine-month period from the day of commencement of continuous ambulatory peritoneal dialysis (CAPD). Significant decreases in the levels of IgG, C3, and opsonic activity occurred with the passage of time in the over-night peritoneal dialysis effluent (PDE). The ability of PDE to inhibit in vitro growth of Staphylococcus epidermidis also decreased. The number of cells in the PDE and their ability to kill S. epidermidis decreased, although there was no significant change in their ability to ingest this organism. These results suggest that the immunological protection of the peritoneal cavity decreases with time, and this may account for the increase in the incidence of peritonitis with length of time on CAPD that some workers have reported.

    Title Release of Hydrogen Peroxide and Expression of Hla-dr and Transferrin Receptors by Monocytes and Peritoneal Macrophages from Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and Normal Controls.
    Date September 1990
    Journal Clinical Immunology and Immunopathology
    Excerpt

    Peritoneal macrophages from patients on continuous ambulatory peritoneal dialysis (CAPD) were investigated with respect to their ability to release H2O2 and express HLA-DR and transferrin receptors (TfR). Release of H2O2 and the proportion of cells expressing HLA-DR were significantly reduced in CAPD macrophages compared with normal peritoneal macrophages but were both similar to blood monocytes. In contrast, about 17% of CAPD peritoneal macrophages and 23% of CAPD blood monocytes expressed TfR but normal peritoneal macrophages and blood monocytes were always negative. These results suggest that the peritoneal macrophages from CAPD patients are relatively immature cells, possibly due to the rapid turnover of cells in CAPD.

    Title Cellular Requirements for First-set Renal Allograft Rejection.
    Date August 1990
    Journal Transplantation Proceedings
    Title Low-dose Cyclosporine or Azathioprine One Year After Renal Transplantation.
    Date July 1990
    Journal Transplantation Proceedings
    Title Properties of Human Peritoneal Macrophages from Continuous Ambulatory Peritoneal Dialysis (capd) Patients.
    Date May 1990
    Journal Fems Microbiology Immunology
    Title Cellular Requirements for Renal Allograft Rejection in the Athymic Nude Rat.
    Date July 1989
    Journal The Journal of Experimental Medicine
    Excerpt

    This study has examined the ability of adoptively transferred CD4+ and CD8+ T cells to mediate rejection of a fully allogeneic DA renal graft in the PVG nude rat. Transfer, at the time of transplantation, of naive CD4+ T cells caused rapid graft rejection and primed CD4+ cells were several times more potent. In contrast, naive or specifically sensitized CD8+ cells were entirely ineffective at mediating renal allograft rejection. Whereas nonrejecting grafts showed only a mild cellular infiltrate, rejecting grafts in CD4+ reconstituted animals showed a substantial infiltrate and many of the infiltrating cells had a phenotype (MRC OX8+, MRC OX19-), consistent with NK cells. Experiments using a mAb (HIS 41) against an allotypic determinant of the leukocyte common antigen confirmed that the majority (greater than 80%) of the cellular infiltrate in rejecting grafts derived from the host rather than from the CD4+ inoculum. Infiltrating mononuclear cells, obtained from rejecting allografts 7 d after transplantation in CD4+-injected PVG nude hosts, showed high levels of in vitro cytotoxicity against not only kidney donor strain Con A blasts but also third-party allogeneic Con A blasts, as well as against both NK and LAK susceptible targets. When splenocytes from nontransplanted nude PVG rats were tested in vitro they also demonstrated high levels of lytic activity against both NK and LAK susceptible targets as well as allogeneic Con A blasts, which were not susceptible to lysis by spleen cells from euthymic rats. These findings suggest that injected CD4+ cells may cause renal allograft rejection by the recruitment of extrathymically derived, widely alloreactive cells into the kidney in this model of graft rejection.

    Title Randomised Trial of Conversion from Cyclosporin to Azathioprine at One Year After Renal Transplantation.
    Date May 1989
    Journal Transplantation Proceedings
    Title Histological Changes in Renal Allografts After Successful Conversion from Cyclosporin A to Azathioprine.
    Date May 1989
    Journal Transplantation Proceedings
    Title Ability of a Cd4-positive, Mrc Ox22 "low" T-cell Subpopulation to Initiate Renal Allograft Rejection in the Athymic Nude Rat.
    Date May 1989
    Journal Transplantation Proceedings
    Title Relationship of Igg, C3 and Transferrin with Opsonising and Bacteriostatic Activity of Peritoneal Fluid from Capd Patients and the Incidence of Peritonitis.
    Date April 1988
    Journal Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
    Excerpt

    IgG, C3 and transferrin in peritoneal dialysis effluent of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) were 1%-2% of those in serum. In contrast, the values in normal peritoneal fluid were not significantly different from those in serum. The three proteins correlated with each other in peritoneal dialysis effluent, but were independent of the amount in the corresponding patients' sera. There was also an overall inverse correlation between total protein in peritoneal dialysis effluent and time on CAPD during the first 6 months of treatment but not thereafter, which suggests that changes in membrane permeability occur during the early months. In peritoneal dialysis effluent, but not in normal peritoneal fluid, there was a correlation between opsonising capacity and IgG or C3 concentrations. An inverse correlation between opsonic activity of peritoneal dialysis effluent and frequency of peritonitis was also found. Peritoneal dialysis effluent permitted significantly faster multiplication of Staphylococcus epidermidis than sera or normal peritoneal fluid, and the growth rate correlated inversely with the transferrin levels in peritoneal dialysis effluent. Overall IgG, C3 and transferrin in peritoneal dialysis effluent are inadequate for optimal opsonising and bacteriostatic activity, and the peritoneal cavities of CAPD patients are therefore immunocompromised sites.

    Title Bactericidal Activity of Peritoneal Macrophages from Continuous Ambulatory Dialysis Patients.
    Date September 1987
    Journal Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
    Excerpt

    A radiometric assay is described for measuring phagocytosis and intracellular killing of Staphylococcus epidermidis by peritoneal cells from continuous ambulatory peritoneal dialysis (CAPD) patients. Using this method it is possible to determine simultaneously and independently, in a single assay, whether peritoneal cells from CAPD patients possess defects in either ingestion or intracellular killing. Assays were performed on peritoneal cells obtained from 28 samples of spent dialysis fluid from CAPD patients. In the majority of cases these cells were able to efficiently phagocytose and kill opsonised Staph. epidermidis, although the degree of intracellular killing was slightly reduced compared with peritoneal cells obtained from eight normal controls undergoing laparoscopy. Overall there was no correlation between the degree of phagocytosis or intracellular killing and susceptibility of patients to peritonitis, although cells from two patients with a high incidence of peritonitis did show abnormally poor ingestion and/or killing. In a number of samples only low numbers of cells (less than 10(6)) were recovered in total from the overnight bags, and there was a significant inverse correlation between the number of cells in the fluid and the length of time on CAPD.

    Title Measurement of Urine Prostaglandin E2 As a Predictor of Acute Renal Transplant Rejection: Preliminary Findings.
    Date July 1985
    Journal Annals of Clinical Biochemistry
    Excerpt

    A radioimmunoassay for prostaglandin E2 (PGE2) in urine was developed and validated. It was used to provide serial measurements in eight renal transplant patients. Urine PGE2 concentration was increased between 1 and 7 days before any changes in the conventional biochemical indicators of acute rejection, serum creatinine and creatinine clearance. The increases in PGE2 concentration varied from 3 to 50 times that of the previous day. These results suggest that measurement of urinary PGE2 may be useful as an early indicator of acute renal transplant rejection.

    Title Delayed Major Arterial Hemorrhage After Transplant Nephrectomy.
    Date November 1984
    Journal Transplantation Proceedings
    Title Early Detection of Obstructed Ureter by Ultrasound Following Renal Transplantation.
    Date February 1984
    Journal Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association
    Excerpt

    Serial ultrasound examinations were carried out following 144 renal transplants. Eleven patients (8%) required surgery for ureteric obstruction and in all cases the ultrasound correctly identified the obstruction at an early stage. One false positive result was obtained with the ultrasound and this compared favourably with both the intravenous urogram (IVU) and isotope renogram. There were false positive and false negative results with both the IVU and renogram in addition to which neither of these techniques, particularly the IVU, is as simple or atraumatic for the patient as the ultrasound. Serial ultrasound examinations have a useful role in the detection of ureteric obstruction as well as being of value in the detection of perinephric fluid collections and acute rejection.

    Title Continuous Ambulatory Peritoneal Dialysis and Pulmonary Function.
    Date January 1984
    Journal Scottish Medical Journal
    Excerpt

    Pulmonary function tests were performed in ten patients established on continuous ambulatory peritoneal dialysis. A decrease in all lung volumes was observed after instillation of dialysate and a further decrease on change from the erect to the supine posture. This change was small and unlikely to have a functionally significant effect in patients with a healthy respiratory system. However, in patients with pre-existing lung disease, respiratory function might be further compromised.

    Title Sclerosing Peritonitis After Capd.
    Date October 1983
    Journal Lancet
    Title Sclerosing Obstructive Peritonitis After Continuous Ambulatory Peritoneal Dialysis.
    Date August 1983
    Journal Lancet
    Title Medical Research Council Trial of Antilymphocyte Globulin in Renal Transplantation. A Multicenter Randomized Double-blind Placebo Controlled Clinical Investigation.
    Date August 1983
    Journal Transplantation
    Excerpt

    A total of 173 patients who received live donor or cadaveric primary or secondary renal transplants at five British hospitals were entered into a randomized double-blind controlled clinical trial of equine antilymphocyte globulin (ALG) administered prophylactically to prevent rejection. The ALG was prepared in the early 1970s and used cultured human lymphoblasts as antigen. Following transplantation all patients were treated with a standard immunosuppressant regimen of steroids and azathioprine and, in addition, were given either 30 mg/kg ALG or placebo daily for 10 days by intravenous infusion. In comparison with more recently produced materials, the ALG employed in this study was of moderate potency in prolonging skin graft survival in monkeys. Primary graft failure occurred in 27 patients (15/86 ALG and 12/87 placebo). At three to five years after transplantation 50 of the remaining patients had died, almost all from diseases relating to their renal condition, and 25 more had suffered complete graft failure. No significant differences were found between patients treated with ALG and placebo in the numbers with functioning grafts during the 3 years following transplantation, in the time between transplantation and the first rejection episode, or in the number of episodes during the first six months after transplantation. This applied whether live or cadaveric grafts were employed. Within the first 6 months of operation, infection was given as a major contributory cause of death in 12 patients treated with ALG and in 5 who received placebo (P greater than 0.1). Infections were also slightly more common during the two weeks following transplantation in those receiving ALG (13/86 ALG, 10/87 placebo). As expected, graft survival was significantly better in patients who received live donor grafts (P = 0.001) and in patients with the least donor-recipient histocompatibility mismatches (P = 0.008). The results of this multicenter trial show no therapeutic benefit to renal graft recipients from the administration of ALG, and suggest that the risks of fatal infection may have been aggravated. Use of such equine ALG in similar dose regimens is therefore, not, justified in renal transplantation, especially if some part of the apparent effects on fatal infections is real. It is stressed that these findings are relevant only to the equine ALG used in this study, which was raised with cultured human lymphoblasts as the antigen, and to ALG prepared in a similar way and of similar potency. It should not be inferred that these results are applicable to ALG prepared in other ways.

    Title Predictive Value of Measurement of Cell-mediated Immunity on Outcome of Renal Transplantation.
    Date January 1982
    Journal Transplantation Proceedings
    Title Renal Transplantation--a Tale of Two Cities.
    Date May 1981
    Journal Scottish Medical Journal
    Title Endogenous Cell-mediated Immunity, Blood Transfusion, and Outcome of Renal Transplantation.
    Date February 1980
    Journal Lancet
    Excerpt

    The cell-mediated immunity (CMI) of a group of patients on regular dialysis was measured by a quantitative dinitrochlorobenzene (DNCB) skin test, the reaction being graded 0--15. The score in these patients varied widely, although the mean was much lower than that occurring in a group of 15 healthy subjects. 55 cadaveric renal allografts were subsequently done in 51 of these patients, and graft survival was assessed at 6 months. The 39 patients with weak DNCB skin reactions had a much higher graft survival (71%) than did the 12 with strong reaction (15%) (p less than 0.01). The weak DNCB reactors also had more pre-transplant blood transfusions. The findings suggest that the CMI of the recipient as measured by the DNCB test has an important influence on subsequent graft survival. This influence may partly be related to pre-transplant blood transfusion.

    Title Influence of Hla Matching and Blood Transfusion on Renal Allograft Survival.
    Date March 1978
    Journal Transplantation
    Excerpt

    One hundred and seven consecutive cadaver kidney transplants have been followed for up to 6 years. The beneficial effect of HLA matching, shown in previous studies, has been confirmed. The 2-year failure rate from rejection was 29% for grafts with less than two incompatibilities, in comparison with a figure of 52% where there were two or more incompatibilities. In contrast to some reports, the presence of HLA antibodies did not have an adverse effect on the survival of first grafts. Patients not transfused prior to transplantation had a much higher 1-year graft failure rate (72%) than those given either frozen-thawed red cells (29%) or whole blood (23%). This apparently beneficial effect of blood transfusion was no greater in patients transfused with more than five units compared with those given less than five units. We believe that blood transfusion has an important influence on the outcome of renal transplantation.

    Title Therapeutic Comparison of Thiol Compounds in Severe Paracetamol Poisoning.
    Date October 1977
    Journal Annals of Clinical Biochemistry
    Excerpt

    Twelve patients with toxic blood concentrations of paracetamol were treated with either cysteamine or amino-acid solution. None of the patients developed severe liver damage, although transient mild biochemical abnormalities developed in three. None of the patients treated with amino-acid solution had side effects due to therapy, whereas all those treated with cysteamine did. It is recommended that amino-acid solutions be used as a temporary measure in patients suspected of massive paracetamol overdose while awaiting estimation of blood paracetamol concentration.

    Title Abnormal Relation Between Exchangeable Sodium and the Renin-angiotensin System in Malignant Hypertension and in Hypertension with Chronic Renal Failure.
    Date May 1973
    Journal Lancet
    Title Severe Rejection of an Hl-a Identical Sibling Renal Transplant.
    Date May 1973
    Journal Tissue Antigens
    Title Factors Affecting the Prognosis in Acute Renal Failure. A Survey of 251 Cases.
    Date April 1973
    Journal The Quarterly Journal of Medicine
    Title Severe Rejection of an Hl-a Identical Sibling Renal Transplant. Results of Mlc Tests.
    Date March 1973
    Journal Tissue Antigens
    Title Total Body Potassium in Non-dialysed and Dialysed Patients with Chronic Renal Failure.
    Date June 1972
    Journal British Medical Journal
    Excerpt

    Total body potassium was studied in 33 patients with chronic renal failure, 18 of whom had been receiving regular dialysis therapy for 1 to 48 months. In nondialysed patients body potassium was not significantly different from normal in the group as a whole, but was significantly greater than normal in three patients, and significantly less than normal in two patients. In 14 of the dialysed patients, both as individuals and as a group, body potassium was not significantly different from normal but in the remaining four it was less than normal.Potassium transfer during dialysis was studied in two patients. Uptake by these two patients of (43)K added to the dialysate (1 mEq K/litre) was measured by whole-body monitoring. Transfer of administered (43)K from the patients to the dialysate was measured by whole-body monitoring and by radioactive and chemical assay of the dialysate. A negative balance due to twice-weekly dialysis of 178 and 244 mEq K/week was found, which with weekly faecal and urine losses of 20-30 mEq K approximately equals the dietary intake of 210-315 mEq K.

    Title Factors Determining Response to Mannitol in Acute Renal Failure.
    Date November 1970
    Journal The American Journal of the Medical Sciences
    Title The Role of Fibrinogen in Renal Disease. 3. Fibrinolytic and Anticoagulant Treatment of Nephrotoxic Serum Nephritis in Mice.
    Date December 1969
    Journal The Journal of Laboratory and Clinical Medicine
    Title Successful Treatment of Three Cases of Very Severe Barbiturate Poisoning.
    Date June 1969
    Journal Lancet
    Title Results of Nephrectomy in Hypertension Associated with Unilateral Renal Disease.
    Date November 1968
    Journal British Medical Journal
    Title Results of Surgery in Hypertension Due to Renal Artery Stenosis.
    Date June 1968
    Journal British Medical Journal
    Title Proteinuria Associated with D-penicillamine Therapy of Cystinuria.
    Date May 1968
    Journal The Journal of Urology
    Title Gynaecomastia in Chronic Renal Failure.
    Date April 1968
    Journal British Medical Journal
    Title Renal Function After Acute Tubular Necrosis.
    Date October 1967
    Journal British Medical Journal
    Title Methods of Forced Diuresis and Its Application in Barbiturate Poisoning.
    Date October 1967
    Journal Lancet
    Title Peritoneal Dialysis in Renal Failure.
    Date August 1967
    Journal Lancet
    Title Role of Insulin in Glucose Intolerance in Uraemia.
    Date May 1967
    Journal Lancet
    Title The Isotope Renogram in the Detection and Assessment of Renal Artery Stenosis.
    Date November 1966
    Journal The Quarterly Journal of Medicine
    Title Detection of Renovascular Hypertension.
    Date March 1966
    Journal Lancet

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