Browsing by Author "Spearman, W"

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    CTLA4 gene polymorphisms in autoimmune hepatitis (AIH) : gene and clinical disease correlations in South African patients
    (2007) Marais, Surita; Hairwadzi, H N; Meissner, P N; Corrigall, A V; Spearman, W
    Also available online. Includes bibliographical references (leaves 76-85).
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    Hypoalbuminaemia in brain-dead donors for liver transplantation
    (Health and Medical Publishing Group, 2005) Ibirogba, SB; Spearman, W; Mall, AS; Shephard, EG; Kahn, D
    Liver transplantation has become established as the treatment of choice for most patients with end-stage liver disease and is performed on a routine basis in most major centres throughout the world. The majority of donors for liver transplantation are brain-dead cadaver donors following either a severe head injury or a massive intracranial haemorrhage. Potential liver donors undergo a rigid screening process before being accepted. This includes a thorough clinical examination to assess the haemodynamic status of the donor and to exclude any overt evidence of liver disease. Blood samples are also taken for viral studies to exclude HIV infection and hepatitis B and C infection, and for liver function tests to exclude liver disease or liver injury. Over the years we have noted that our liver donors often had low serum albumin levels, although this has not been formally documented. A review of the literature revealed that hypoalbuminaemia associated with severe head injury has been documented previously. However the impact of brain death on serum albumin levels has not been studied previously. The present study was therefore undertaken to document serum albumin levels in brain-dead cadaver donors.
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    Overview of a paediatric renal transplant programme
    (2006) McCulloch, M; Gajjar, P; Spearman, W; Burger, H; Sinclair, P; Savage, L; Morrison, C; Davies, C; Ruysch van Dugteren, GPA; Maytham, D; Wiggelinkhuizen, J; Pascoe, M D; McCurdie, F J; Pontin, A; Muller, E; Numanoglu, A; Millar, A J W; Rode, H; Khan, D
    INTRODUCTION: Renal transplantation is the therapy of choice for children with end-stage renal failure. There are many challenges associated with a paediatric programme in a developing country where organs are limited. METHODS: A retrospective review was undertaken of 149 paediatric renal transplants performed between 1968 and 2006 with specific emphasis on transplants performed in the last 10 years. Survival of patients and grafts was analysed and specific problems related to drugs and infections were reviewed. RESULTS: On review of the total programme, 60% of the transplants have been performed in the last 10 years, with satisfactory overall patient and graft survival for the first 8 years post transplant. At this point, transfer to adult units with non-compliance becomes a significant problem. Rejection is less of a problem than previously but infection is now a bigger issue--specifically tuberculosis (TB), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections with related complications. A wide variety of drugs are available for tailoring immunosuppression to minimise side-effects. CONCLUSION: It is possible to have a successful paediatric transplant programme in a developing country. However, to improve long-term outcomes certain issues need to be addressed, including reduction of nephrotoxic drugs and cardiovascular risk factors and providing successful adolescent to adult unit transition.