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Long-Term Survival after Cadaveric Renal Transplantation
884
TRANSPLANTATION
etry, Louisiana State University Medical Center, New Orleans, Louisiana N. Y. State J. Med., 82: 1571-1575 (Oct.) 1982 These investigators describe the Bogalusa heart study that was initiated as part of a comprehensive program to assess cardiovascular risk factor variables in children. It was begun as a prospective investigation of the distribution, interrelationships and course-over-time of risk factor variables in children. Particular attention was directed to methods for obtaining reproducible blood pressure levels and their changes over time. With an interest in studying relationships between genetic and environmental factors in the development of cardiovascular disease a dietary study was incorporated into the program. The studies are being conducted in a semirural community, Bogalusa, Louisiana, with a biracial population of approximately 22,000, with 5,000 children, a third of whom are black. Selected anthropometric measurements, serum lipid, lipoprotein and blood pressure levels are being obtained using trained observers, and registered and licensed nurses following specific protocols. The mercury sphygmomanometer and an automatic blood pressure recorder are being used to document indirect blood pressure measurements. The first, fourth and fifth Korotkoff phases are recorded. Additional observations include smoking behavior, certain personality traits and type A-B behavior. Major problems were found in the methods of obtaining blood pressure and in the definition of hypertension in children. At this time it is virtually impossible to arrive at a precise or even a clinically satisfactory definition of hypertension in youth. Eventually, decisions will have to be made as to when to begin intervention-preventive or therapeutic measures. Unfortunately, no set rules or guidelines can be established now. The observations on tracking and predictability of basal blood pressure suggest that essential hypertension has its origin in youth and likely already is existing in a significant number of children who are presumed to be healthy. To resolve this problem a program was developed in neighboring Franklinton as a feasibility study and a first approximation of how one might treat children who are projected to have a high risk for adult essential hypertension. Questions under study include can blood pressure levels be lowered or modulated by usual clinical measures, and can sodium intake be altered and perhaps the weight of overweight children be reduced? Observations after 6 months of such management are that children have responded with blood pressure levels reading in the mid range level. One of the most difficult things observed is the resistance to change of life style and dietary habits. The authors conclude that this beginning model of intervention should provide others with an opportunity to improve this approach and eventually develop methods useful for the care of a single child or a community wide program. These studies are exciting and may provide the future approach to preventing hypertension in the general population. W. W.H. 5 figures, 13 references
Arterial Hypertension Developing 10 Years After Radiotherapy for Wilms's Tumour 0. KosKIMIES, Children's Hospital, University of Helsinki, Helsinki, Finland Brit. Med. J., 285: 996-998 (Oct. 9) 1982 This study concerns 3 patients who suffered hypertension > 10 years after radiotherapy for Wilms tumor. The hypertension was believed to have been caused by the radiation to the
contralateral kidney, which was sufficient to cause radiation nephritis but not to inhibit compensatory hypertrophy. The author concludes that long-term surveillance for hypertension is necessary in patients who have received radiation therapy when the kidney may have been affected by radiation scatter. D.K.M. 1 table, 3 references
TRANSPLANTATION Long-Term Survival After Cadaveric Renal Transplantation E. SAVDIE, J. F. MAHONY, R. J. CATERSON, J. H. STEWART, S. ETHREDGE, B. G. STOREY AND A. G. R. SHEIL, Department of Medical Research, Kanematsu Memorial Institutes, Sydney Hospital, Sydney, NSW, Australia Brit. Med. J., 285: 1160-1163 (Oct. 23) 1982 This report concerns 404 consecutive first cadaver kidney transplants performed since 1967. Of interest is the observation that >90 per cent of the kidney transplantations performed in Australia involve cadaver donors. The causes of renal failure in the current series are glomerulonephritis (36 per cent), analgesic nephropathy (22 per cent), reflux nephropathy (12 per cent), hypertension (7 per cent), polycystic disease (4 per cent) and diabetic nephropathy (1 per cent). The relatively high incidence of end stage renal disease secondary to analgesic nephropathy is in keeping with the relatively high incidence of analgesic nephropathy in Australia. In the current series the 5 and 10-year patient survival times are 61 and 41 per cent, respectively, and the 5 and 10-year allograft survival times are 46 and 36 per cent. Since 1967 allograft survival has remained relatively constant but patient survival has improved. Results for 43 consecutive second cadaveric renal transplants were similar to the results in the larger group of first cadaver transplants. In Australia 82 per cent of the patients with functioning renal allografts are used, whereas only 46 per cent of the patients on dialysis are used. The ratio of patients with a functioning transplant to those maintained on dialysis in Australia is approximately 1:1, whereas in the United States the ratio is 1:3 and in Japan it is 1:17. The authors believe that renal transplantation offers a better way of life than chronic dialysis and they are concerned regarding the trend away from renal transplantation noted in other countries. D.K.M. 6 figures, 27 references
Renal and Segmental Pancreatic Grafting With Draining of Exocrine Secretion and Initial Continuous Intravenous Cyclosporin A in a Patient With InsulinDependent Diabetes and Renal Failure R. Y. CALNE, D. J. G. WHITE, K. ROLLES, T. J. DUFFY AND T. KASS, University Department of Surgery, Addenbrooke's Hospital, Cambridge, England Brit. Med. J., 285: 677-680 (Sept. 11) 1982 This report concerns a patient with end stage renal disease and insulin-dependent diabetes mellitus who received a renal allograft and a segmental pancreatic allograft from the same cadaver donor. Exocrine pancreatic drainage was directed into the bowel. Cyclosporin A was infused intravenously on a continued basis, with an attempt to maintain serum concentration
TRANSPLANTATION
etry, Louisiana State University Medical Center, New Orleans, Louisiana N. Y. State J. Med., 82: 1571-1575 (Oct.) 1982 These investigators describe the Bogalusa heart study that was initiated as part of a comprehensive program to assess cardiovascular risk factor variables in children. It was begun as a prospective investigation of the distribution, interrelationships and course-over-time of risk factor variables in children. Particular attention was directed to methods for obtaining reproducible blood pressure levels and their changes over time. With an interest in studying relationships between genetic and environmental factors in the development of cardiovascular disease a dietary study was incorporated into the program. The studies are being conducted in a semirural community, Bogalusa, Louisiana, with a biracial population of approximately 22,000, with 5,000 children, a third of whom are black. Selected anthropometric measurements, serum lipid, lipoprotein and blood pressure levels are being obtained using trained observers, and registered and licensed nurses following specific protocols. The mercury sphygmomanometer and an automatic blood pressure recorder are being used to document indirect blood pressure measurements. The first, fourth and fifth Korotkoff phases are recorded. Additional observations include smoking behavior, certain personality traits and type A-B behavior. Major problems were found in the methods of obtaining blood pressure and in the definition of hypertension in children. At this time it is virtually impossible to arrive at a precise or even a clinically satisfactory definition of hypertension in youth. Eventually, decisions will have to be made as to when to begin intervention-preventive or therapeutic measures. Unfortunately, no set rules or guidelines can be established now. The observations on tracking and predictability of basal blood pressure suggest that essential hypertension has its origin in youth and likely already is existing in a significant number of children who are presumed to be healthy. To resolve this problem a program was developed in neighboring Franklinton as a feasibility study and a first approximation of how one might treat children who are projected to have a high risk for adult essential hypertension. Questions under study include can blood pressure levels be lowered or modulated by usual clinical measures, and can sodium intake be altered and perhaps the weight of overweight children be reduced? Observations after 6 months of such management are that children have responded with blood pressure levels reading in the mid range level. One of the most difficult things observed is the resistance to change of life style and dietary habits. The authors conclude that this beginning model of intervention should provide others with an opportunity to improve this approach and eventually develop methods useful for the care of a single child or a community wide program. These studies are exciting and may provide the future approach to preventing hypertension in the general population. W. W.H. 5 figures, 13 references
Arterial Hypertension Developing 10 Years After Radiotherapy for Wilms's Tumour 0. KosKIMIES, Children's Hospital, University of Helsinki, Helsinki, Finland Brit. Med. J., 285: 996-998 (Oct. 9) 1982 This study concerns 3 patients who suffered hypertension > 10 years after radiotherapy for Wilms tumor. The hypertension was believed to have been caused by the radiation to the
contralateral kidney, which was sufficient to cause radiation nephritis but not to inhibit compensatory hypertrophy. The author concludes that long-term surveillance for hypertension is necessary in patients who have received radiation therapy when the kidney may have been affected by radiation scatter. D.K.M. 1 table, 3 references
TRANSPLANTATION Long-Term Survival After Cadaveric Renal Transplantation E. SAVDIE, J. F. MAHONY, R. J. CATERSON, J. H. STEWART, S. ETHREDGE, B. G. STOREY AND A. G. R. SHEIL, Department of Medical Research, Kanematsu Memorial Institutes, Sydney Hospital, Sydney, NSW, Australia Brit. Med. J., 285: 1160-1163 (Oct. 23) 1982 This report concerns 404 consecutive first cadaver kidney transplants performed since 1967. Of interest is the observation that >90 per cent of the kidney transplantations performed in Australia involve cadaver donors. The causes of renal failure in the current series are glomerulonephritis (36 per cent), analgesic nephropathy (22 per cent), reflux nephropathy (12 per cent), hypertension (7 per cent), polycystic disease (4 per cent) and diabetic nephropathy (1 per cent). The relatively high incidence of end stage renal disease secondary to analgesic nephropathy is in keeping with the relatively high incidence of analgesic nephropathy in Australia. In the current series the 5 and 10-year patient survival times are 61 and 41 per cent, respectively, and the 5 and 10-year allograft survival times are 46 and 36 per cent. Since 1967 allograft survival has remained relatively constant but patient survival has improved. Results for 43 consecutive second cadaveric renal transplants were similar to the results in the larger group of first cadaver transplants. In Australia 82 per cent of the patients with functioning renal allografts are used, whereas only 46 per cent of the patients on dialysis are used. The ratio of patients with a functioning transplant to those maintained on dialysis in Australia is approximately 1:1, whereas in the United States the ratio is 1:3 and in Japan it is 1:17. The authors believe that renal transplantation offers a better way of life than chronic dialysis and they are concerned regarding the trend away from renal transplantation noted in other countries. D.K.M. 6 figures, 27 references
Renal and Segmental Pancreatic Grafting With Draining of Exocrine Secretion and Initial Continuous Intravenous Cyclosporin A in a Patient With InsulinDependent Diabetes and Renal Failure R. Y. CALNE, D. J. G. WHITE, K. ROLLES, T. J. DUFFY AND T. KASS, University Department of Surgery, Addenbrooke's Hospital, Cambridge, England Brit. Med. J., 285: 677-680 (Sept. 11) 1982 This report concerns a patient with end stage renal disease and insulin-dependent diabetes mellitus who received a renal allograft and a segmental pancreatic allograft from the same cadaver donor. Exocrine pancreatic drainage was directed into the bowel. Cyclosporin A was infused intravenously on a continued basis, with an attempt to maintain serum concentration