S A Snowden

King's College London, Londinium, England, United Kingdom

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Publications (29)142.52 Total impact

  • PA Andrews · P J O'Donnell · SA Dilly · SA Snowden · M Bewick

    No preview · Article · Dec 1997 · Nephrology Dialysis Transplantation
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    ABSTRACT: Many patients with circulating antibodies to human leucocyte antigens (anti-HLA) are highly sensitised against renal transplantation and are liable to immediate graft loss through hyperacute rejection. Our aim was to find out whether removal of anti-HLA immediately before renal transplantation prevented hyperacute graft rejection. 13 highly sensitised patients underwent cadaveric renal transplants immediately after immunoadsorption (IA) treatment to remove anti-HLA. Before IA, 12 patients had a positive crossmatch against donor cells either by cytotoxic or flow-cytometric assay; results for one patient were equivocal. Renal biopsy samples were obtained 20 min after removal of the vascular clamps in nine patients. There was no evidence of hyperacute rejection in six of the nine patients; the other three patients showed glomerular thrombosis but no other evidence of hyperacute rejection. Two of these three grafts were functioning at 31 months of follow-up. Six episodes of acute rejection occurred in five patients during the first month after transplantation and overall there were 13 rejection episodes in nine patients. At latest follow-up (median 26 months, range 9-42), 12 of 13 patients were alive and seven of 13 grafts were surviving with a median plasma creatinine concentration of 185 mumol/L (range 106-296) in the functioning grafts. No graft was lost as a result of classic hyperacute rejection. Immediate pretransplant IA can prevent hyperacute rejection and provide an opportunity for successful transplantation in highly sensitised patients.
    No preview · Article · Dec 1996 · The Lancet
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    ABSTRACT: The function of renal allografts in patients who had received pretransplant immunoadsorption in order to remove cytotoxic anti-HLA antibodies was studied. We reviewed 6 patients who received a graft which functioned beyond 3 months; the mean follow-up period was 76 (range 62-89) months. Two grafts have been lost from chronic rejection, at 12 and 62 months, respectively. The mean plasma creatinine levels at 1 and 5 years were 169 (range 143-211) mumol/l and 155 (range 92-235) mumol/l, respectively (1.91, range 1.62-2.39, mg/dl and 1.75, range 1.04-2.66 mg/dl, respectively). The major source of morbidity during long-term follow-up has been the occurrence of renal artery stenosis in 5 patient and renal vein stenosis in 1. In conclusion, the 5-year graft survival and function was good in patients who received immunoadsorption and whose grafts survived beyond the first 3 months after transplantation.
    No preview · Article · Feb 1996 · Nephron
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    ABSTRACT: Transplant renal artery stenosis (TRAS) is a common complication after transplantation and is an important cause of graft dysfunction. Damage from graft rejection, trauma, and atherosclerosis have been implicated as possible causes. We reviewed all 917 patients transplanted in our unit since 1978 to study the prevalence, clinical features, and possible causes of TRAS. Seventy-seven patients with TRAS were identified. The detected incidence was 2.4% before the introduction of color doppler ultrasonography (CDU) and rose to 12.4% after CDU was introduced in 1985, giving an overall incidence of 8.4% during a mean follow-up period of 6.9 years. The TRAS group was compared with a control group of 77 transplanted patients matched for age, year of transplant, sex, and number of previous grafts. Mean ages for the study and control groups were 43.6 +/- 15 and 44.8 +/- 13.7 yr. A total of 25% of cases of TRAS were diagnosed within the first 8 wk of transplantation and in 60% within the first 30 wk (median = 23 wk). All patients were treated with angioplasty, 28 patients had recurrence of TRAS requiring multiple angioplasties (maximum 5) and 1 went on to have surgery. Angioplasty resulted in a significant fall in plasma creatinine. Patient and graft survival were significantly worse in the TRAS group: 69% vs. 83% (P < 0.05) and 56% vs. 74% (P < 0.05) (TRAS vs. Control), respectively. There was a significantly higher incidence of rejection, especially cellular rejection in the TRAS group, 0.67 vs. 0.35 episodes per patient (P < 0.01) (TRAS vs. Control). Recurrence but not occurrence of TRAS was associated with the use of cyclosporine.
    No preview · Article · Feb 1996 · Transplantation
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    ABSTRACT: Transplant renal artery stenosis (TRAS) is a common complication after transplantation and is an important cause of graft dysfunction. Damage from graft rejection, trauma, and atherosclerosis have been implicated as possible causes, We reviewed all 917 patients transplanted in our unit since 1978 to study the prevalence, clinical features, and possible causes of TRAS, Seventy-seven patients with TRAS were identified. The detected incidence was 2.4% before the introduction of color doppler ultrasonography (CDU) and rose to 12.4% after CDU was introduced in 1985, giving an overall incidence of 8.4% during a mean follow-up period of 6.9 years, The TRAS group was compared with a control group of 77 transplanted patients matched for age, year of transplant, sex, and number of previous grafts, Mean ages for the study and control groups were 43.6+/-15 and 44.8+/-13.7 yr. A total of 25% of cases of TRAS were diagnosed within the first 8 wk of transplantation and in 60% within the first 30 wk (median=23 wk). All patients were treated with angioplasty, 28 patients had recurrence of TRAS requiring multiple angioplasties (maximum 5) and 1 went on to have surgery, Angioplasty resulted in a significant fall in plasma creatinine, Patient and graft survival were significantly worse in the TRAS group: 69% vs, 83% (P<0.05) and 56% vs. 74% (P<0.05) (TRAS vs. Control), respectively, There was a significantly higher incidence of rejection, especially cellular rejection in the TRAS group, 0.67 vs, 0.35 episodes per patient (P<0.01) (TRAS vs. Control), Recurrence but not occurrence of TRAS was associated with the use of cyclosporine.
    No preview · Article · Jan 1996 · Transplantation
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    ABSTRACT: This 4-year prospective study investigated the reasons for high levels of gangrene and major amputation in diabetic renal transplant patients and whether regular multidisciplinary foot care could reduce morbidity. All foot lesions were documented and investigated in 50 diabetic patients, mean age 49.2 +/- 11.0 (SD) years, duration of diabetes 25.3 +/- 9.0 years, time since renal transplantation 60.2 +/- 35.1 months, who attended a special foot clinic monthly for education, vascular and neurological assessment, podiatry and footwear. Foot lesions included: neuropathic ulcers, ischaemic ulcers, traumatic lesions, Charcot's arthropathy, pathological fracture. Treatment included antibiotics, podiatry, footwear, and angioplasty or distal bypass where appropriate. Only 13 patients were deemed ischaemic but peripheral neuropathy was a very common finding (mean VPT 24.8 +/- 12.9 V). Gangrene and major amputations showed a decrease on previous years and healing times for lesions were similar to those previously reported in diabetic patients without renal transplants. The majority of foot lesions, both in soft tissue and bone, were related to neuropathy and trauma and responded well to optimal foot care within the renal unit. Gangrene and major amputations were usually preventable.
    No preview · Article · Aug 1995 · Diabetic Medicine
  • A O Phillips · S A Snowden · A N Hillis · M Bewick
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    ABSTRACT: During 1990 in Britain 60.7 patients per million of the population were accepted for renal transplantation but fewer than 35 patients per million received a renal transplant. More transplants would be available if non-heart beating donors were used. We report a retrospective study of transplantation of renal grafts from non-heart beating donors.
    No preview · Article · May 1994 · BMJ Clinical Research
  • S R Nelson · S A Snowden · S Sutherland · H M Smith · V Parsons · M Bewick
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    ABSTRACT: Renal transplantation of patients with previous or ongoing hepatitis B virus infection has been tempered with a concern that immunosuppression may lead to viral replication and progressive liver damage. However, renal transplantation as therapy for end-stage renal failure in these patients improves quality of life and reduces the risk of body fluid exposure to their carers. To assess the long-term outcome of renal transplantation in hepatitis-BsAg-positive patients a retrospective study was carried out on the patients transplanted in this unit since 1969. Seventy-six patients received 98 grafts up to December 1991; follow-up was available on 68. Thirty-one of the 68 patients died; the causes of death were infective 23, cardiovascular 6, liver failure 4, pancreatitis 2, aspiration 1, GI haemorrhage 1, and stopped therapy 1. Serological markers of hepatitis B virus infection did not correlate with outcome. The risk of developing liver failure after renal transplantation appears small in the hepatitis-BsAg-positive patients and no patient should be denied a renal transplant on the basis of serological tests.
    No preview · Article · Feb 1994 · Nephrology Dialysis Transplantation
  • A O Phillips · M Bewick · S A Snowden · A N Hillis · B M Hendry
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    ABSTRACT: This paper assesses the impact of age on the outcome of cadaveric renal transplantation. Data are presented on 99 consecutive patients undergoing first renal allografts at one unit. Patients are divided into those aged less than 50 (n = 53), patients between 50 and 60 (n = 16), and those aged 60 years and over (n = 30). There was no significant difference in graft survival at one year between the three groups. There was however an increased mortality with increasing recipient age (1.9%, 12.5% and 20.0% respectively for each age group). The effect of increasing donor age on graft survival was also studied. Graft survival at two years for first grafts was not influenced by donor age. We conclude that age alone is not a criterion for exclusion of patients from transplant programs. In addition we provide data to support the use of elderly donors as a potential source of cadaveric renal grafts for certain patients.
    No preview · Article · Jan 1994 · Clinical nephrology
  • Source
    A O Phillips · N R Patel · S A Snowden · M Bewick · B M Hendry

    Full-text · Article · Feb 1993 · Nephrology Dialysis Transplantation
  • A Grenfell · M Bewick · S Snowden · P J Watkins · V Parsons
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    ABSTRACT: Renal failure is an important cause of morbidity and mortality in diabetic patients, who account for up to 25 per cent of new patients entering renal replacement therapy. Between 1980 and 1989, 651 patients with renal failure were treated at King's College Hospital, of whom 177 (27 per cent) had diabetes. Of these 177 patients 148 had diabetic nephropathy (65 non-insulin-dependent), while the rest had other renal diseases. Of the non-insulin-dependent diabetics, 45 per cent (29 of 65) were Asian or Afro-Caribbean compared to only 12 per cent (10/83) of the insulin-dependent diabetics. Ninety-two patients (62 per cent) have received a renal transplant with actuarial patient survival of 82 per cent at 1 year and 61 per cent at 4 years. Both patient and graft survival have been improved by the introduction of cyclosporin A. Continuous ambulatory peritoneal dialysis is the main form of dialysis and has allowed increasing numbers of patients to be dialysed, especially older individuals with non-insulin-dependent diabetes. Rehabilitation is best in those with functioning transplants: 21 patients (19 with functioning grafts) have survived for longer than 5 years. Diabetic complications before and after renal replacement therapy are described. Cardiovascular disease is especially common and may limit the success of renal replacement therapy.
    No preview · Article · Jan 1993 · The Quarterly journal of medicine
  • D Taube · A Palmer · K Welsh · M Bewick · S Snowden · M Thick

    No preview · Article · Mar 1989 · Transplantation Proceedings
  • A Palmer · M Bewick · K Welsh · S Snowden · V Parsons · D Taube

    No preview · Article · Jul 1988 · Transplantation Proceedings
  • A Grenfell · M Bewick · V Parsons · S Snowden · D Taube · P J Watkins
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    ABSTRACT: Reports of renal replacement therapy in diabetes usually refer to patients with insulin-dependent diabetes mellitus (IDDM) only, and little is known about renal failure in non-insulin-dependent diabetics (NIDDM). A high proportion, 46/141 (32%), of the diabetics treated at our unit since 1974 had NIDDM. They were older at treatment (56 +/- 9 years, mean +/- SD) compared to the IDDM patients (39 +/- 10 years, p less than 0.001), and had a shorter duration of diabetes (13 +/- 8 years versus 23 +/- 8 years, p less than 0.001). Asians and Afro-Caribbeans accounted for 48% of the NIDDM patients (22/46) compared to only 7% of those having IDDM (6/95, p less than 0.0001). Non-diabetic renal disease accounted for the renal failure in 32% (15/46) of the NIDDM patients but only in 10.5% (10/95) of the IDDMs (p less than 0.001). Despite these differences the prevalence of other diabetic complications (retinopathy, neuropathy, and cardiovascular disease) was similar. Patient survival after transplantation was poorer in NIDDM than IDDM (23% and 57%, respectively, at 2 years). Survival on dialysis was equally poor in NIDDM and IDDM. Thus, NIDDM patients treated for renal failure are more commonly non-European and more often have non-diabetic renal disease. Yet other diabetic complications occur to the same extent in both IDDM and NIDDM patients with diabetic nephropathy.
    No preview · Article · Apr 1988 · Diabetic Medicine

  • No preview · Article · Dec 1987 · Bone
  • D Taube · K I Welsh · M Bewick · F E Dische · A Palmer · V Parsons · S Snowden

    No preview · Article · Mar 1987 · Transplantation Proceedings
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    ABSTRACT: Renal transplantation for diabetic nephropathy prolongs survival and the return of fertility makes pregnancy possible. We describe a successful pregnancy in a 38-year-old diabetic renal transplant recipient despite blindness, gangrenous toes, cardiac impairment, and both sensory and autonomic neuropathy. Renal function remained stable throughout the pregnancy which was complicated by supine hypertension, postural hypotension and increasing proteinuria. Fetal distress and increasing proteinuria precipitated delivery by Caesarean section at 29 weeks of a female infant weighting 1.1 kg. Following delivery, hypertension improved, gangrene resolved, proteinuria decreased, and renal function remained stable. Pregnancy in long-standing diabetic patients with renal transplants, although hazardous, may be successful yet the maternal morbidity and mortality makes them inadvisable.
    No preview · Article · Apr 1986 · Diabetic Medicine
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    V Parsons · M Bewick · S A Snowden · A Eddleston · P M Lock · A H Uttley

    Preview · Article · Jul 1984 · British medical journal (Clinical research ed.)
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    ABSTRACT: Three patients with congenital hepatic fibrosis and childhood-type autosomal recessive polycystic kidney disease are reported. Portal hypertension in two of the children was decompressed surgically by lieno-renal shunting, and the renal failure in two children has been successfully treated with renal transplantation. Prophylactic porta-caval shunting followed by renal transplantation is ideally suited to the sequence of events occurring clinically in the intermediate form of this condition, preventing complications of bleeding from oesophageal varices and hyperplenism. The relationship of congenital hepatic fibrosis with the various forms of polycystic kidney disease is discussed and classified.
    No preview · Article · Feb 1981 · The Quarterly journal of medicine
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    ABSTRACT: In a retrospective survey of 134 patients undergoing bilateral nephrectomy from 1969 to 1980 it was found that the commonest indications were hypertension (60%) and infection/reflux (22%). Operation in hypertensive dialysis patients was followed by a fall in blood pressure in 70% (SE 9%) at one and 3 months while normotensive patients having their kidneys out for other reasons had a 47% (SE 11%) incidence of hypertension at one month and 7 out of 10 were still hypertensive at 3 months. When operation was performed in transplanted patients, 7 of 10 hypertensives had a fall in pressure, one of 6 normotensive persons had an increase, an use of antihypertensive drugs fell from 13/16 to 4 of 16 patients. The mortality was 10.4% (SE 2.6%) overall, the mortality of operations which included an unplanned splenectomy was significantly higher. There were 34 other complications in 25 patients. Complications, but not deaths, were more frequent in operations performed in dialysis patients rather than at the same time as, or after, a transplant. Over 12 years the ratio of bilateral nephrectomy to renal transplant operations has fallen from 8% (1969-1971) to 18% (1978 to present). The decrease is partly due to a fall in the number of operations for hypertension in dialysis patients and may be related to the appearance of beta-blocker and new vasodilator drugs.
    Full-text · Article · Feb 1980 · Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association

Publication Stats

644 Citations
142.52 Total Impact Points

Institutions

  • 1973-1996
    • King's College London
      • • School of Medicine
      • • Department of Immunobiology
      Londinium, England, United Kingdom