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Improvement of Kidney Transplant Survival After Graft Pretreatment With Cyclosporin A
SURGICAL TECHNIQUES, EQUIPMENT AND INSTRUMENTS
effect of transfusion was greatest in previous transplant recipients and minimal in parous women. Actuarial graft survival in male patients stratified for transfusion, transplant number and percentage of reactive antibody level showed significant enhancement in first graft recipients associated with transfusion regardless of percentage of reactive antibody level. However, the benefit of transfusion was lower in regrafted recipients. Prior loss did not significantly affect graft survival in unsensitized patients but was associated with decreased graft survival in sensitized patients. The effect of sensitization on survival stratified for transfusion, prior pregnancy and transplantation was of significant detriment in transfused, regrafted male patients and transfused, previously pregnant female patients. This study, while limited only to µw""'"'"""' who received transplants, indicated that these variables should be considered when the effects of sensitization and graft survival are analyzed. W. J. C. 5 figures, 4 tables, 22 references
medical therapy aimed at preventing rejection. The authors reviewed the results of 214 recipients with a functioning aHograft for 2 years to determine what were significant variables account for graft survival. It appears that living-related ents have better graft survival. when compared to cadaver recipients. Graft survival also was significantly better in v~'Osv,,c,,u with a 2-year serum creatinine level <2.0. A greater Df!)DrfftJon of patients with a 2-year serum creatinine level >3 experienced >2 rejection episodes. Among recipients with a year serum creatinine level <2.0 living-related grafts achieve better graft survival than cadaver grafts. Major cu,m}""''u,m,_,:,; of transplantation were more common in patients with a rn.· claver graft, 2-yea:r serum creatinine levels >3.0 or patients >4Eo years old. Of the 214 patients 142 (66 per cent) are al.ive with the functioning graft. Of these 142 patients 132 have achieved complete rehabilitation and are rrnac1;10iarntg their full pre-illness level of activity. W. J. C. 4 figures, 5 tables, 8 references
Hl..A-lJRw6 and Renal Allogx-aft Rejection
Improvement of Kidney Transplant Survival After Graft Pretreatment With Cyclos:po:r:i.n A
G. F. J.
F. H. J. CLAAS, J. B. COHEN AND J. J. VAN Roon, unJuunN.J,iuru Foundation and Department Immunoru,,,,,,·_~,,,v Hospital, Rijnsburgerweg, Leiden, The Netherlands HENDRIKS,
D'AMARO,
G. G.
G. M.
TH. SCHREUDER,
PERSIJN,
J.
RUCKER,
L. H.
TOLEDO-PEREYRA,
G. H.
MACKENZIE AND
D. A. GORDON, Department of Surgery, Sections Research and Transplantation, Mount Carmel pital, Detroit, Michigan
Brit. Med. J., 286: 85-87 (Jan. 8) 1983
Transplantation, 34: 356-359 (Dec.) 1982
HLA-DRw6-positive patients are high responders to certain renal antigens. Therefore, a study was conducted on the outcome of 247 first renal allografts in 74 DRw6-positive and 173 DRw6-negative recipients. The effectiveness of matching for HLA-DR. determinant in both groups also was analyzed. The 1-year g-raft survival in DRw6-positive P"'"'"'·"'""' was 59 per cent compared to 75 per cent in DRw6-negative recipients (p = A striking difference between the 2 groups was that HLA-DR matching significantly improved renal allograft survival in the DRw6-positive patients. In those patients the 1-year survival of HLA-DR-identical grafts was 95 per cent compared to only 38 per cent for 2-DR mismatched grafts (p = 0.009). In DRw6-negative patients only a slight beneficial effect of HLA-DR matching was observed (83 versus 72 per cent at 1 year for the 0-DR and 2-DR mismatched grafts, respectively) (p >0.05). These findings are clear evidence that DRw6-positive patients (about a quarter of the patients on the waiting list of Eurotransplant) should be given HLA-DR-identical kidney transplants only. Authors' abstract. 3 1 table, 6 references
In an effort to i.rnprove kidney allograft survival after trans .. plantation cyclosporin A was used as a graft under varying conditions. It was established that 12.5 mg. cyclosporin A per kidney was the ideal concentration for pre-treatment. The authors then analyzed the role of temperature in the flushing solution to determine whether this parameter would have a significant effect on allograft survival. Un.related mongrel dogs were used as donors and recipients for aJJ the studies. Control kidneys were flushed with uepa,m,1u,u Ringer's lactate at 25 and 4C, respectively. The second group was treated with a similar concentration with 12.5 mg. porin A added to the solution. All donor kidneys we:re transplanted into the right iliac fossa of bilaterally nephrectomi.zed recipients. All animals were placed on minimal immunosuppres·sion until death or sacrifice. It was found that warmer temperatures (25C) improved the prolonging effect of cyclosporin A in survival of pre-t:reated kidney grafts. It appears that graft pretreatment with cyclosporin A could significantly prolong allograft survival.. Although the exact mechanism of action of cyclosporin A during graft pre-treatment is not known i.t is possible that temperature may affect the reaction A without the allograft's cell membrane and in this way allograft survival. W. J. C. 2 figures, 2 tables, 10 references
Long-Term Results of Renal fiamrplantation in Recipients With a Functioning Graft for 2 Years
R
A. C. NOVICK, w. E. BRAUN, D. STEINMULLER, C. R. GREENSTREET AND J. HINTON, Departments of and Hypertension and Nephrology, The Cleveland Clinic Foundation, Cleveland, Ohio ABELE,
BuszTA,
Transpiantation, 34: 264-267
1982
The evaluation oflong-term efficacy of renal transplantation is now possible as more patients with extended post-transplant intervals are available for study. A successful outcome of transplantation may be defined as long-term maintenance of normal renal function, complete patient rehabilitation and avoidance of major morbidity from the transplant operation or
SURGICAL TECHNIQUES, EQUIPMENT AND INSTRUMENTS Fournier's Gangrene of the Scrotum: A Pooirly Defined Syndrome or a Misnomer
RC. LAMB AND G. L. JULER, Department of Surgery, Veterans Administration Medical Center, Long Beach, and the UniMedicine, versity of California, Irvine, College California Arch. Surg., 118: 38-40 (Jan.) 1983
effect of transfusion was greatest in previous transplant recipients and minimal in parous women. Actuarial graft survival in male patients stratified for transfusion, transplant number and percentage of reactive antibody level showed significant enhancement in first graft recipients associated with transfusion regardless of percentage of reactive antibody level. However, the benefit of transfusion was lower in regrafted recipients. Prior loss did not significantly affect graft survival in unsensitized patients but was associated with decreased graft survival in sensitized patients. The effect of sensitization on survival stratified for transfusion, prior pregnancy and transplantation was of significant detriment in transfused, regrafted male patients and transfused, previously pregnant female patients. This study, while limited only to µw""'"'"""' who received transplants, indicated that these variables should be considered when the effects of sensitization and graft survival are analyzed. W. J. C. 5 figures, 4 tables, 22 references
medical therapy aimed at preventing rejection. The authors reviewed the results of 214 recipients with a functioning aHograft for 2 years to determine what were significant variables account for graft survival. It appears that living-related ents have better graft survival. when compared to cadaver recipients. Graft survival also was significantly better in v~'Osv,,c,,u with a 2-year serum creatinine level <2.0. A greater Df!)DrfftJon of patients with a 2-year serum creatinine level >3 experienced >2 rejection episodes. Among recipients with a year serum creatinine level <2.0 living-related grafts achieve better graft survival than cadaver grafts. Major cu,m}""''u,m,_,:,; of transplantation were more common in patients with a rn.· claver graft, 2-yea:r serum creatinine levels >3.0 or patients >4Eo years old. Of the 214 patients 142 (66 per cent) are al.ive with the functioning graft. Of these 142 patients 132 have achieved complete rehabilitation and are rrnac1;10iarntg their full pre-illness level of activity. W. J. C. 4 figures, 5 tables, 8 references
Hl..A-lJRw6 and Renal Allogx-aft Rejection
Improvement of Kidney Transplant Survival After Graft Pretreatment With Cyclos:po:r:i.n A
G. F. J.
F. H. J. CLAAS, J. B. COHEN AND J. J. VAN Roon, unJuunN.J,iuru Foundation and Department Immunoru,,,,,,·_~,,,v Hospital, Rijnsburgerweg, Leiden, The Netherlands HENDRIKS,
D'AMARO,
G. G.
G. M.
TH. SCHREUDER,
PERSIJN,
J.
RUCKER,
L. H.
TOLEDO-PEREYRA,
G. H.
MACKENZIE AND
D. A. GORDON, Department of Surgery, Sections Research and Transplantation, Mount Carmel pital, Detroit, Michigan
Brit. Med. J., 286: 85-87 (Jan. 8) 1983
Transplantation, 34: 356-359 (Dec.) 1982
HLA-DRw6-positive patients are high responders to certain renal antigens. Therefore, a study was conducted on the outcome of 247 first renal allografts in 74 DRw6-positive and 173 DRw6-negative recipients. The effectiveness of matching for HLA-DR. determinant in both groups also was analyzed. The 1-year g-raft survival in DRw6-positive P"'"'"'·"'""' was 59 per cent compared to 75 per cent in DRw6-negative recipients (p = A striking difference between the 2 groups was that HLA-DR matching significantly improved renal allograft survival in the DRw6-positive patients. In those patients the 1-year survival of HLA-DR-identical grafts was 95 per cent compared to only 38 per cent for 2-DR mismatched grafts (p = 0.009). In DRw6-negative patients only a slight beneficial effect of HLA-DR matching was observed (83 versus 72 per cent at 1 year for the 0-DR and 2-DR mismatched grafts, respectively) (p >0.05). These findings are clear evidence that DRw6-positive patients (about a quarter of the patients on the waiting list of Eurotransplant) should be given HLA-DR-identical kidney transplants only. Authors' abstract. 3 1 table, 6 references
In an effort to i.rnprove kidney allograft survival after trans .. plantation cyclosporin A was used as a graft under varying conditions. It was established that 12.5 mg. cyclosporin A per kidney was the ideal concentration for pre-treatment. The authors then analyzed the role of temperature in the flushing solution to determine whether this parameter would have a significant effect on allograft survival. Un.related mongrel dogs were used as donors and recipients for aJJ the studies. Control kidneys were flushed with uepa,m,1u,u Ringer's lactate at 25 and 4C, respectively. The second group was treated with a similar concentration with 12.5 mg. porin A added to the solution. All donor kidneys we:re transplanted into the right iliac fossa of bilaterally nephrectomi.zed recipients. All animals were placed on minimal immunosuppres·sion until death or sacrifice. It was found that warmer temperatures (25C) improved the prolonging effect of cyclosporin A in survival of pre-t:reated kidney grafts. It appears that graft pretreatment with cyclosporin A could significantly prolong allograft survival.. Although the exact mechanism of action of cyclosporin A during graft pre-treatment is not known i.t is possible that temperature may affect the reaction A without the allograft's cell membrane and in this way allograft survival. W. J. C. 2 figures, 2 tables, 10 references
Long-Term Results of Renal fiamrplantation in Recipients With a Functioning Graft for 2 Years
R
A. C. NOVICK, w. E. BRAUN, D. STEINMULLER, C. R. GREENSTREET AND J. HINTON, Departments of and Hypertension and Nephrology, The Cleveland Clinic Foundation, Cleveland, Ohio ABELE,
BuszTA,
Transpiantation, 34: 264-267
1982
The evaluation oflong-term efficacy of renal transplantation is now possible as more patients with extended post-transplant intervals are available for study. A successful outcome of transplantation may be defined as long-term maintenance of normal renal function, complete patient rehabilitation and avoidance of major morbidity from the transplant operation or
SURGICAL TECHNIQUES, EQUIPMENT AND INSTRUMENTS Fournier's Gangrene of the Scrotum: A Pooirly Defined Syndrome or a Misnomer
RC. LAMB AND G. L. JULER, Department of Surgery, Veterans Administration Medical Center, Long Beach, and the UniMedicine, versity of California, Irvine, College California Arch. Surg., 118: 38-40 (Jan.) 1983