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P. Rowe, M. Foster, R. Richardson, A. Morgan, R. Burden (1988)
Chronic renal allograft rejection and cyclosporine.Transplantation proceedings, 20 5 Suppl 6
J. Colonna, D. Winston, J. Brill, L. Goldstein, Marilyn Hoff, J. Hiatt, W. Quiñones-Baldrich, K. Ramming, R. Busuttil (1988)
Infectious complications in liver transplantation.Archives of surgery, 123 3
Canadian Multicentre Transplant Study Group (1983)
A randomized clinical trial of cyclosporine in cadaveric renal transplantationN Engl J Med, 309
N. Tilney, T. Strom, G. Vineyard, J. Merrill (1978)
Factors contributing to the declining mortality rate in renal transplantation.The New England journal of medicine, 299 24
R. Kirkman, T. Strom, M. Weir, N. Tilney (1982)
LATE MORTALITY AND MORBIDITY IN RECIPIENTS OF LONG‐TERM RENAL ALLOGRAFTSTransplantation, 34
J. Dummer, Ann Hardy, Abbas Poorsattar, Monto Ho (1983)
Early infections in kidney, heart, and liver transplant recipients on cyclosporine.Transplantation, 36 3
W. Hoy, A. May, R. Freeman (1982)
Primary renal transplant wound infections.New York state journal of medicine, 81 10
Dunn DL (1990)
Problems related to immunosuppression: posttransplant infection and malignancyCrit Care Clin, 6
K. Brayman, D. Dafoe, W. Smythe, C. Barker, L. Perloff, A. Naji, I. Fox, R. Grossman, D. Jorkasky, S. Starr, H. Friedman, S. Plotkin (1988)
Prophylaxis of serious cytomegalovirus infection in renal transplant candidates using live human cytomegalovirus vaccine. Interim results of a randomized controlled trial.Archives of surgery, 123 12
R. Rubin, J. Wolfson, A. Cosimi, N. Tolkoff-Rubin (1981)
Infection in the renal transplant recipient.The American journal of medicine, 70 2
G. Kyriakides, R. Simmons (1975)
Wound Infections in Renal Transplant Wounds: Pathogenetic and Prognostic FactorsAnnals of Surgery, 182
P. Peterson, R. Ferguson, D. Fryd, H. Balfour, R. Simmons (1982)
Infectious Diseases in Hospitalized Renal Transplant Recipients: A Prospective Study of a Complex and Evolving ProblemMedicine, 61
Collaborative DHPG Treatment Study Group (1986)
Treatment of serious cytomegalovirus infections with 9-(1,3-dihydro-2-propoxymethyl)guanine in patients with AIDS and other immunodeficienciesN Engl J Med, 314
Sollinger HW Fox BC (1990)
A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora and the cost-benefit of prophylaxisAm J Med, 89
Najarian JS Dunn DL (1990)
Principles and Management of Surgical Infection
M. Henry, B. Sommer, R. Ferguson (1985)
Beneficial effects of cyclosporine compared with azathioprine in cadaveric renal transplantation.American journal of surgery, 150 5
C. Peters, P. Peterson, P. Marabella, R. Simmons, J. Najarian (1983)
Continuous sulfa prophylaxis for urinary tract infection in renal transplant recipients.American journal of surgery, 146 5
E. Gehan (1965)
A GENERALIZED WILCOXON TEST FOR COMPARING ARBITRARILY SINGLY-CENSORED SAMPLES.Biometrika, 52
R. Brooks, R. Brooks, J. Hofflin, J. Hofflin, S. Jamieson, E. Stinson, J. Remington, J. Remington (1985)
Infectious complications in heart-lung transplant recipients.The American journal of medicine, 79 4
S. Marker, R. Howard, R. Simmons, J. Kalis, D. Connelly, J. Najarian, H. Balfour (1981)
Cytomegalovirus infection: a quantitative prospective study of three hundred twenty consecutive renal transplants.Surgery, 89 6
R. Simmons, R. Migliori (1988)
Infection prophylaxis after successful organ transplantation.Transplantation proceedings, 20 6 Suppl 8
McDonald FD Murphy JF (1976)
Factors affecting the frequency of infection in renal transplant recipientsArch Intern Med, 136
P. Peterson, H. Balfour, D. Fryd, R. Ferguson, R. Simmons (1981)
Fever in renal transplant recipients: causes, prognostic significance and changing patterns at the University of Minnesota Hospital.The American journal of medicine, 71 3
EORTC International Microbial Therapy Project Group (1984)
Trimethoprim-sulfamethoxazole in the prevention of infection in neutropenic patientsJ Infect Dis, 150
N. Tolkoff-Rubin, A. Cosimi, P. Russell, R. Rubin (1982)
A controlled study of trimethoprim-sulfamethoxazole prophylaxis of urinary tract infection in renal transplant recipients.Reviews of infectious diseases, 4 2
D. Fryd, M. Strand, P. D, N. Ascher, W. Payne, R. Simmons, D. Sutherland (1985)
A Single Institution, Randomized, Prospective Trial of Cyclosporine Versus Azathioprine‐Antilymphocyte Globulin for Immunosuppression in Renal Allograft RecipientsAnnals of Surgery, 201
H. Balfour, B. Chace, J. Stapleton, R. Simmons, D. Fryd (1989)
A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts.The New England journal of medicine, 320 21
R. Burgos-Calderón, G. Pankey, J. Figueroa (1971)
Infection in kidney transplantation.Surgery, 70 3
H. Masur, Jhoong Cheigh, W. Stubenbord (1982)
Infection following renal transplantation: a changing pattern.Reviews of infectious diseases, 4 6
G. Washer, G. Schröter, T. Starzl, R. Weil (1983)
Causes of death after kidney transplantation.JAMA, 250 1
Eickhoff Tc (1973)
Infectious complications in renal transplant recipients.Transplantation proceedings, 5 3
J. Murphy, F. Mcdonald, M. Dawson, A. Reite, J. Turcotte, F. Fekety (1976)
Factors Affecting the Frequency of Infection in Renal Transplant RecipientsJAMA Internal Medicine, 136
R. Simmons, H. Balfour, C. López, S. Mauer, C. Kjellstrand, T. Buselmeier, J. Najarian (1975)
Infection in immunosuppressed transplant recipients.The Surgical clinics of North America, 55 6
D. Shaffer, S. Hammer, A. Monaco (1987)
Infectious complications with the use of cyclosporine versus azathioprine after cadaveric kidney transplantation.American journal of surgery, 153 4
Snover DC Stock PG (1987)
Biopsy guided immunosuppressive therapy in treatment of liver transplant rejection: an individualized approachClin Transplant, 1
E. Ramos, S. Karmi, S. Alongi, F. Dagher (1980)
Infectious Complications in Renal Transplant RecipientsSouthern Medical Journal, 73
K. Gottesdiener (1989)
Transplanted infections: donor-to-host transmission with the allograft.Annals of internal medicine, 110 12
R. Rubin, N. Tolkoff-Rubin (1988)
Opportunistic infections in renal allograft recipients.Transplantation proceedings, 20 6 Suppl 8
D. Dunn, J. Mayoral, K. Gillingham, CYNTHIA Loeffler, Kenneth Brayman, M. Kramer, Alejo Erice, Henry Balfour, Courtney Fletcher, R. Bolman, A. Matas, William Payne, D. Sutherland, J. Najarian (1991)
Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir.Transplantation, 51 1
Abstract • To improve our understanding of posttransplant infections, we analyzed bacterial, viral, fungal, parasitic, and other infections in 604 consecutive recipients of kidney (n = 518), kidney-pancreas (n = 82), kidney-liver (n = 3), or kidney-islet (n = 1) allografts (355 cadaveric, 14 living-unrelated, 235 living-related donors) who also received cyclosporine, azathioprine, and prednisone immunosuppression. Recipients of cadaveric grafts received additional induction immunosuppression (antilymphocyte globulin or murine monoclonal antibody OKT3). Rejection episodes were treated with high-dose steroids, and either antilymphocyte globulin or OKT3 was administered when clinically indicated. Perioperative antibiotics and posttransplant prophylactic acyclovir sodium or ganciclovir sodium, trimethoprim-sulfamethoxazole, and clotrimazole or nystatin (Mycostatin) were administered to all recipients. Two hundred thirteen patients (35.3%) were found to have had no identifiable infections, while 391 (64.7%) had either isolated bacterial (97 [16.1 %]), viral (53 [8.8%]), or fungal (34 [5.6%]) infections or combination (concurrent or sequential) infections with bacterial plus viral (46 [7.6%]), bacterial plus fungal (66 [10.9%]), viral plus fungal (20 [3.3%]), bacterial plus viral plus fungal (64 [10.6%]), or bacterial plus viral plus fungal plus parasitic (11 [1.8%]) pathogens in the posttransplantation period. Renal allograft survival (percentage, actuarial method) was diminished in patients with infections at both 1 year (91% vs 83%) and 3 years (81% vs 76%) after transplantation, as was actuarial patient survival (1 year, 97% vs 92%; 3 years, 93% vs 88%). We conclude that infection remains a major cause of both patient demise and allograft loss following successful solid-organ transplantation. (Arch Surg. 1992;127:38-48) References 1. Najarian JS, Fryd DS, Strand M, et al. A single institution, randomized, prospective trial of cyclosporine versus azathioprine-antilymphocyte globulin for immunosuppression in renal allograft recipients . Ann Surg . 1985;201:142-157.Crossref 2. Canadian Multicentre Transplant Study Group. A randomized clinical trial of cyclosporine in cadaveric renal transplantation . N Engl J Med . 1983;309:809-815.Crossref 3. Dunn DL. Problems related to immunosuppression: posttransplant infection and malignancy . Crit Care Clin . 1990;6:955-977. 4. Tilney NL, Strom TB, Vineyard GC, Merrill JP. Factors contributing to the declining mortality rate in renal transplantation . N Engl J Med . 1978;299:1321-1325.Crossref 5. Schweitzer EJ, Matas AJ, Gillingham KJ, et al. Causes of renal allograft loss: progress in the 80's, challenges for the 90's. Ann Surg. In press. 6. Brayman KL, Dafoe DC, Smythe WR, et al. 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N Engl J Med . 1986;314:801-805.Crossref 11. Peters C, Peterson P, Marabella P, Simmons RL, Najarian JS. Continue sulfa prophylaxis for urinary tract infection in renal transplant recipients . Am J Surg . 1983;146:589-593.Crossref 12. Fox BC, Sollinger HW, Belzer FO, Maki DG. A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora and the cost-benefit of prophylaxis . Am J Med . 1990;89:255-274.Crossref 13. Peterson PK, Ferguson R, Fryd DS, Balfour HH, Rynasiewicz J, Simmons RL. Infectious diseases in hospitalized renal transplant recipients: a prospective study of a complex and evolving problem . Medicine . 1982;61:360-372.Crossref 14. Masur H, Cheigh JS, Stubenbord WT. Infection following renal transplantation: a changing pattern . Rev Infect Dis . 1982;4:1208-1219.Crossref 15. Shaffer D, Hammer SM, Monaco AP. 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Fever in renal transplant recipients: causes, prognostic significance and changing patterns at the University of Minnesota Hospital . Am J Med . 1981;71:345-351.Crossref 29. Kirkman RL, Strom TB, Weir MR, Tilney NL. Late mortality and morbidity in recipients of long-term renal allografts . Transplantation . 1982;34:347-351.Crossref 30. Stock PG, Snover DC, Payne WD, et al. Biopsy guided immunosuppressive therapy in treatment of liver transplant rejection: an individualized approach . Clin Transplant . 1987;1:179-186. 31. Gehan E. A generalized Wilcoxon test for comparing arbitrarily singly-sensored samples . Biometrika . 1965;52:203-223.Crossref 32. Washer GF, Schroter GP, Starzl TE, Weil R. Causes of death after kidney transplantation . JAMA . 1983;250:49-54.Crossref 33. Marker SC, Howard RJ, Simmons RL, et al. Cytomegalovirus infection: a quantitative prospective study of three hundred twenty consecutive renal transplants . Surgery . 1981;89:660-671. 34. Kyriakides GK, Simmons RL, Najarian JS. Wound infections in renal transplant wounds: pathogenetic and prognostic factors . Ann Surg . 1975;186:770-775.Crossref 35. EORTC International Microbial Therapy Project Group. Trimethoprim-sulfamethoxazole in the prevention of infection in neutropenic patients . J Infect Dis . 1984;150:372-397.Crossref 36. Tolkoff-Rubin ME, Cosimi AB, Russell PS, Rubin RH. A controlled study of trimethoprim-sulfamethoxazole prophylaxis of urinary tract infection in renal transplant recipients . Rev Infect Dis . 1982;4:614-618.Crossref 37. Hoy WE, May AG, Freeman RB. Primary renal transplant wound infections . N Y State J Med . 1981;81:1469-1473. 38. Henry ML, Sommer BG, Ferguson RM. Beneficial effects of cyclosporine compared with azathioprine in cadaveric renal transplantation . Am J Surg . 1985;150:533-536.Crossref
Archives of Surgery – American Medical Association
Published: Jan 1, 1992
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