- Email: [email protected]
Analysis of Interracial Variation in Kidney Transplant and Patient Survival
1086
TRANSPLANTATION
review of the kidney and its role in hypertension. I would recommend reading the entire article.
The Heterogeneity of Essential Hypertension. Relation Between Lithium Efflux and Sodium Content of Erythrocytes and a Family History of Hypertension B. MORGAN AND C. DAVIDSON, Department of Chemical Pathology, University of Leeds and Birch Hill Hospital, Rochdale, Lancashire
G. GLEGG, D.
Lancet, 2: 891-894 (Oct. 23) 1982 Essential hypertension long has been attributed to some change in the balance or distribution of sodium. The sodium content of erythrocytes, lymphocytes and leukocytes is increased, owing to inhibition of the sodium pumps. This inhibition disappears from leukocytes when the blood pressure is lowered with diuretics and probably is caused by a circulating inhibitor of sodium transport. The lithium efflux (sodium-sodium dependent exchange) and sodium content of erythrocytes were measured in 75 patients with untreated essential hypertension. The average values of both were higher than those of normotensive control subjects. Values above the range in the controls were found only in patients with a family history of hypertension and in these the frequency of increased lithium efflux was 76 per cent and of increased sodium content it was 36 per cent. Measurement of lithium efflux and sodium content, together with the family history, allows patients with essential hypertension to be categorized into subgroups for a better assessment of prognosis and for a more rational selection of therapy. The h~terogeneity of essential hypertension is again indicated by these results. H. D. P. 4 figures, 19 references
Revascularization of Kidneys With Totally Occluded Renal Arteries R.H. ALEXANDER AND B. W. BRIENT, Vascular Surgery Section and the General Surgery Section, Veterans Administration Medical Center and the Department of Surgery, University of Florida School of Medicine, Gainesville, Florida South. Med. J., 75: 1087-1092 (Sept.) 1982 The authors perform aorticorenal bypass operations on 4 patients with totally occluded renal arteries. The outcome revealed early graft failure in 1 case and 2 failures 4 to 6 months later. One graft remains functioning at 2 years and is normotensive. Review-of >70 other cases in which revascularization of kidneys with totally occluded renal arteries was attempted revealed an over-all patency rate of 96 per cent and relief of hypertension in 77 per cent of the cases. According to the authors indications for revascularization are 1) a successful nephrogram, or collateral vessel or distal arterial filling by angiography, 2) lateralizing renin determination, 3) a biopsy revealing intact glomeruli and 4) brisk back-bleeding from the artery. F. T. A. 5 figures, 1 table, 37 references
Editorial comment. The authors present a broad overview of the problem and an excellent review of the literature. Their indications for revascularization based upon arteriography, renal biopsy, renin determinations and findings at the time of the operation are sound and well presented. G. D. F.
TRANSPLANTATION Pretransplant Blood Transfusions and Related Kidney Allograft Survival I.
Department of Clinical Immunology, Division of Transplantation Surgery, Departments of Surgery and Nephrology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden FEHRMAN,
Transplantation, 34: 46-49 (July) 1982 The impact of pre-transplant blood transfusions was analyzed in 130 recipients of related kidney grafts. There was no difference in the graft survival rate between the 85 transfused recipients and the 45 nontransfused recipients but acute rejection episodes occurred less frequently in the former group, the incidence being 49 versus 69 per cent (p <0.05). Multi-transfused (>20 transfusions) patients had a significantly better graft survival rate than patients receiving 1 to 20 transfusions and patients receiving no blood. The 3-year survival rates in these groups were 93, 70 and 66 per cent, respectively. Pre-transplant dialysis had no effect on transplantation outcome. Author's abstract. 2 figures, 3 tables, 16 references
Analysis of Interracial Variation in Kidney Transplant and Patient Survival I. TERASAKI, UCLA Tissue Typing Laboratory, UCLA School of Medicine, Los Angeles, California
S. T. PERDUE AND P.
Transplantation, 34: 75-77 (Aug.) 1982 A number of studies have suggested that black recipients of renal allografts have lower survival rates than do white recipients and that black renal grafts do not survive well in recipients of either race. It has been suggested that differences in susceptibility to nephrosclerosis or differences in transfusion patterns Inight account for this finding. In an effort to evaluate this question further data were reviewed in detail. It was found that rough data tended to bear out this observation relative to racial differences in patient and graft survival but stratification of data by individual reporting institutions revealed that the differences were the result of variations between centers rather than racial variations within centers. Thus, centers with the poorest survivals had the largest number of black patients, while centers with predominantly white patients had the best survival figures. No differences could be identified as a consequence of nephrosclerosis or transfusion factors between the racial groups. T. D. A. 1 figure, 1 table, 4 references
Long-Term Alternate Day Steroid Therapy in Renal Transplantation. A Controlled Study N. w. LEVIN, G. SZEGO, A. T. VULPETTI AND L. E. Department of Medicine, Division of Nephrology, and Department of Therapeutic Radiology, Division of Radiation Physics, Henry Ford Hospital, Detroit, Michigan
F. DUMLER, PREUSS,
Transplantation, 34: 78-82 (Aug.) 1982 In a group of 76 adult allograft recipients alternate-day maintenance steroid therapy was compared to daily steroid therapy. All patients initially received daily steroid therapy that was
TRANSPLANTATION
review of the kidney and its role in hypertension. I would recommend reading the entire article.
The Heterogeneity of Essential Hypertension. Relation Between Lithium Efflux and Sodium Content of Erythrocytes and a Family History of Hypertension B. MORGAN AND C. DAVIDSON, Department of Chemical Pathology, University of Leeds and Birch Hill Hospital, Rochdale, Lancashire
G. GLEGG, D.
Lancet, 2: 891-894 (Oct. 23) 1982 Essential hypertension long has been attributed to some change in the balance or distribution of sodium. The sodium content of erythrocytes, lymphocytes and leukocytes is increased, owing to inhibition of the sodium pumps. This inhibition disappears from leukocytes when the blood pressure is lowered with diuretics and probably is caused by a circulating inhibitor of sodium transport. The lithium efflux (sodium-sodium dependent exchange) and sodium content of erythrocytes were measured in 75 patients with untreated essential hypertension. The average values of both were higher than those of normotensive control subjects. Values above the range in the controls were found only in patients with a family history of hypertension and in these the frequency of increased lithium efflux was 76 per cent and of increased sodium content it was 36 per cent. Measurement of lithium efflux and sodium content, together with the family history, allows patients with essential hypertension to be categorized into subgroups for a better assessment of prognosis and for a more rational selection of therapy. The h~terogeneity of essential hypertension is again indicated by these results. H. D. P. 4 figures, 19 references
Revascularization of Kidneys With Totally Occluded Renal Arteries R.H. ALEXANDER AND B. W. BRIENT, Vascular Surgery Section and the General Surgery Section, Veterans Administration Medical Center and the Department of Surgery, University of Florida School of Medicine, Gainesville, Florida South. Med. J., 75: 1087-1092 (Sept.) 1982 The authors perform aorticorenal bypass operations on 4 patients with totally occluded renal arteries. The outcome revealed early graft failure in 1 case and 2 failures 4 to 6 months later. One graft remains functioning at 2 years and is normotensive. Review-of >70 other cases in which revascularization of kidneys with totally occluded renal arteries was attempted revealed an over-all patency rate of 96 per cent and relief of hypertension in 77 per cent of the cases. According to the authors indications for revascularization are 1) a successful nephrogram, or collateral vessel or distal arterial filling by angiography, 2) lateralizing renin determination, 3) a biopsy revealing intact glomeruli and 4) brisk back-bleeding from the artery. F. T. A. 5 figures, 1 table, 37 references
Editorial comment. The authors present a broad overview of the problem and an excellent review of the literature. Their indications for revascularization based upon arteriography, renal biopsy, renin determinations and findings at the time of the operation are sound and well presented. G. D. F.
TRANSPLANTATION Pretransplant Blood Transfusions and Related Kidney Allograft Survival I.
Department of Clinical Immunology, Division of Transplantation Surgery, Departments of Surgery and Nephrology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden FEHRMAN,
Transplantation, 34: 46-49 (July) 1982 The impact of pre-transplant blood transfusions was analyzed in 130 recipients of related kidney grafts. There was no difference in the graft survival rate between the 85 transfused recipients and the 45 nontransfused recipients but acute rejection episodes occurred less frequently in the former group, the incidence being 49 versus 69 per cent (p <0.05). Multi-transfused (>20 transfusions) patients had a significantly better graft survival rate than patients receiving 1 to 20 transfusions and patients receiving no blood. The 3-year survival rates in these groups were 93, 70 and 66 per cent, respectively. Pre-transplant dialysis had no effect on transplantation outcome. Author's abstract. 2 figures, 3 tables, 16 references
Analysis of Interracial Variation in Kidney Transplant and Patient Survival I. TERASAKI, UCLA Tissue Typing Laboratory, UCLA School of Medicine, Los Angeles, California
S. T. PERDUE AND P.
Transplantation, 34: 75-77 (Aug.) 1982 A number of studies have suggested that black recipients of renal allografts have lower survival rates than do white recipients and that black renal grafts do not survive well in recipients of either race. It has been suggested that differences in susceptibility to nephrosclerosis or differences in transfusion patterns Inight account for this finding. In an effort to evaluate this question further data were reviewed in detail. It was found that rough data tended to bear out this observation relative to racial differences in patient and graft survival but stratification of data by individual reporting institutions revealed that the differences were the result of variations between centers rather than racial variations within centers. Thus, centers with the poorest survivals had the largest number of black patients, while centers with predominantly white patients had the best survival figures. No differences could be identified as a consequence of nephrosclerosis or transfusion factors between the racial groups. T. D. A. 1 figure, 1 table, 4 references
Long-Term Alternate Day Steroid Therapy in Renal Transplantation. A Controlled Study N. w. LEVIN, G. SZEGO, A. T. VULPETTI AND L. E. Department of Medicine, Division of Nephrology, and Department of Therapeutic Radiology, Division of Radiation Physics, Henry Ford Hospital, Detroit, Michigan
F. DUMLER, PREUSS,
Transplantation, 34: 78-82 (Aug.) 1982 In a group of 76 adult allograft recipients alternate-day maintenance steroid therapy was compared to daily steroid therapy. All patients initially received daily steroid therapy that was