http://repub.eur.nl/res/aut/782/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/5380/ 1988-01-01T00:00:00Z In a consecutive series of 146 kidney transplant recipients treated with cyclosporin A a strong correlation between matching for the HLA-A, HLA-B, and HLA-DR loci specificities and outcome of the grafts was observed in male recipients with non-O blood groups. Such a beneficial effect of matching was not found in female patients or male patients with blood group O. In these patients survival of the grafts at one year was good irrespective of the number of HLA-A, B, and DR mismatches. Also in 47 male heart transplant recipients immune responsiveness against mismatched HLA antigens was related to blood group. A significantly higher incidence of rejection episodes was observed in male patients with non-O blood groups (n = 32) than in those with blood group O (n = 15). Matching for HLA-DR reduced the number of acute rejection episodes in male patients with non-O blood. These findings may help explain the controversial reports about the importance of HLA matching in organ transplantation. Furthermore, as most candidates for heart transplantation are male and not of blood group O, the higher incidence of graft rejection in these patients underscores the need for an exchange strategy of donor hearts. http://repub.eur.nl/res/pub/4210/ 1986-01-01T00:00:00Z From this brief overview the arguments have become clear why further studies are needed to verify that the problem of unnecessary sudden cardiac death can best be tackled by a strategy aimed at early and complete revascularization. Whether such a strategy begins with intravenous injection of rt-PA at home or requires subsequent intracoronary manipulation when obstruction persists, whether by thrombolysis with other agents, PTCA or bypass surgery, is in itself a moot point. The main aim should be to offer this strategy as the best chance to reduce the unnecessary sudden death rate which presently accounts for between 25 and 50% of all cardiac deaths. This approach deserves consideration particularly since earlier approaches employing cardioprotective efforts by beta blockade or by anti arrhythmic agents have patently shown that they cannot tackle the problem in a convincing manner. http://repub.eur.nl/res/pub/5341/ 1986-01-01T00:00:00Z http://repub.eur.nl/res/pub/37899/ 1983-12-07T00:00:00Z The aim of this thesis is the description of the outcome of isolated aortacoronary bypass operations, both regarding the short term effects i.e. the operative mortality as well as the Long term results i.e. the general wellbeing and survival probability of the patients over the years. The main indication for this type of surgery is and always has been, persisting angina pectoris despite extensive pharmacological therapy. The outcome of surgery therefore, should be judged, among other things, by the presence and severity of this syndrome in the post-operative period. To place these data in perspective, a review of the Literature on surgical therapy of angina is provided in chapter 2. As discussed in chapter 3, it has become apparent over the years that the perception of the severity of angina pectoris is changeable and very difficult to quantify. Still an attempt has been made, to analyse the data on this complaint, although it is realised that it is fraught with errors as simplifications are required when Large numbers are to be judged. Improved survival has by now become an important issue to justify bypass surgery. A multivariate analysis of the factors which influence survival is provided in chapter 4. For comparison, the survival probability of the general population in the Netherlands, matched for age and sex, has been related to the data of the patients under study. In chapter 5 the evolution in post-operative chest pain is documented, while the results of re-operations of patients who underwent their primary operation at the Thoraxcenter, are discussed in chapter 6. In chapter 7 a correlation is sought between the presence of pain in the chest and the extent of vascular involvement in the pre- and postoperative angiograms. Patency of the grafts and progression of disease in relation to post-operative pain is discussed as well in these chapters. Chapter 8 contains a general but critical discussion of bypass surgery in an attempt to view, from all angles, the relative merits and disadvantages of this currently so popular procedure. This study would not have been possible without the generous help of our patients. First by their part in the design of the questionnaire and Later by their responding to it in such Large numbers. To emphasize that this material ultimately relates to the specific problem of the individual patient, the histories of 4 patients are represented in a detailed but compressed form. Their stories reflect, better perhaps than statistics, what it means to have a "BYPASS OPERATION" http://repub.eur.nl/res/pub/4089/ 1983-01-01T00:00:00Z -- http://repub.eur.nl/res/pub/4093/ 1983-01-01T00:00:00Z Of 1041 patients with consecutive aortocoronary bypass operations, 53 (5.1%) underwent reoperation during a mean follow-up time of three and a half years. The operative mortality of first operations was 1.2%, and of reoperations 3.8%. The anatomical reason for reoperation was failure of the bypass graft in 41 (77%) patients, which in 18 was accompanied by progression of disease. Progression alone was seen in seven (13%). When symptoms occurred within six months after the first operation, failure of the bypass graft(s) was nearly always found--in 32 out of 36 instances. Progression in non-bypassed arteries was seen only when symptoms occurred later. Late results in angina pectoris were less favourable in the group undergoing reoperation: 31 (65%) of the 48 operated on twice and 406 (46%) of the 877 patients operated on once still had angina at late follow-up. The same fraction in both groups was improved by operation: 88% versus 89%. http://repub.eur.nl/res/pub/4098/ 1983-01-01T00:00:00Z http://repub.eur.nl/res/pub/4102/ 1983-01-01T00:00:00Z The incidence of angina pectoris (AP) after bypass surgery was assessed in 1041 patients operated on consecutively between 1971 and 1980. Of the 977 survivors, 920 (94%) participated in the study with a followup time varying from 1 to 10 years (mean 3.5 years). Post-operative angina pectoris was present at 1 year in 277 patients (30%), at 3 years in 46%, at 8 years in 50%. The pain limited usual physical activities in 17.5%, 30% and 25%, respectively at these times. Nonetheless, 89% of the respondents felt improved by surgery. Factors without predictive value for late outcome were sex, number of pre-operative diseased vessels, and pre-operative ejection fraction. A correlation was found between post-operative AP and younger age at surgery in the males only (P less than 0.001); between AP and patency rate of the bypass graft (P less than 0.005) and with the status of the coronary arterial tree at three years post-operatively (P less than 0.001) in both sexes. The percentage of patients with recurrent AP increased with time after surgery up to 3 years, but remained stable thereafter. In conclusion, post-operative AP seems initially related to decreased functioning of the bypass graft, later to progression of coronary sclerosis in the native circulation.