- Email: [email protected]
Percutaneous Transluminal Angioplasty Treatment of Renal Transplant Artery Stenosis
196
TRANSPLANTATION
from 1 to 5 years after transplantation. The HLA-B matching was found to be more beneficial than the HLA-A. HLA matching appears to be more beneficial in male recipients, blood group A recipients and subjects not presensitized to antigens of the HLA system. Matching for HLA-A and B also significantly improved the survival of second grafts. The HLA matching has a better prognosis when the number of incompatible antigens is carried by the donor alone than when the number of antigens is shared by donor and recipient. Preliminary analysis in the influence of matching for the HLA-DR antigens on cadaver graft survival may prove to be beneficial. F. T. A. 5 figures, 2 tables, 12 references
Maximal Hydration During Anesthesia Increases Pulmonary Arterial Pressures and Improves Early Function of Human Renal Transplants M. CARLIER, J.-P. SQUIFFLET, Y. PIRSON, B. GRIBOMONT AND G. P. J. ALEXANDRE, Departments of Anesthesiology and Transplantation, Cliniques Universitaires Saint Luc, Brussels, Belgium Transplantation, 34: 201-204 (Oct.) 1982 From January 1, 1979 to December 1, 1980 the authors studied the effect of maximal hydration during operation in 120 primary human cadaver transplants. All patients had a Swan Ganz catheter placed to monitor peroperative pulmonary arterial pressures. These patients were divided into group 1 with pulmonary arterial pressure <20 mm. Hg and a diastolic pulmonary arterial pressure <15 mm. Hg, and group 2 with pulmonary arterial pressure >20 mm. Hg and a diastolic pulmonary arterial pressure > 15 mm. Hg at the time of removal of the vessel clamps. At the beginning of the operation pulmonary arterial pressure, cijastolic pulmonary arterial pressure and central venous pressure were higher in group 2. At the time of clamp release these pressures as well as systolic blood pressure were also higher in group 2. The frequency of postoperative acute tubular necrosis was 36 per cent in group 1, while only 6 per cent in group 2. This study emphasizes that the pulmonary arterial pressure levels should be increased to >20 mm. Hg by adequate hydration to improve immediate function of the graft and to avoid postoperative acute tubular necrosis. F. T. A. 4 tables, 16 references
Percutaneous Transluminal Angioplasty Treatment of Renal Transplant Artery Stenosis R. A. GROSSMAN, D. C. DAFOE, R. B. SHOENFELD, E. J. RING, G. K. McLEAN, J. A. 0LEAGA, D. B. FREIMAN, A. NAJI, L. J. PERLOFF AND C. F. BARKER, Departments of Surgery, Nephrology, and Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Transplantation, 34: 339-343 (Dec.) 1982 The incidence of renal transplant artery stenosis in renal allograft recipients is approximately 10 per cent. Renal transplant artery stenosis frequently causes hypertension and may decrease renal allograft function. Between June 1979 and May 1982, 241 renal transplants were performed at the authors' hospital. Because of increasing hypertension in 24 patients an arteriogram was performed and significant renal transplant artery stenosis was found in 17 patients (7 per cent). All 17 patients underwent percutaneous transluminal angioplasty. Of these 17 patients 15 were successful on angiographic analysis. Of these 15 successfully dilated patients 13 had long-term
allograft survival with decreased blood pressure after percutaneous transluminal angioplasty. After a mean followup of 67 weeks blood pressure was reduced from a systolic of 184 ± 24 mm. Hg before percutaneous transluminal angioplasty to 135 ± 15 mm. Hg after percutaneous transluminal angioplasty and from a diastolic of 115 -± 10 mm. Hg before percutaneous transluminal angioplasty to 87 ± 11 mm. Hg after percutaneous transluminal angioplasty. Followup angiography was performed on 9 patients about 61 weeks after percutaneous transluminal angioplasty and showed no evidence of recurrent renal transplant artery stenosis. The majority of patients continue to require antihypertensive drugs but less potent ones than before percutaneous transluminal angioplasty. The complications of percutaneous transluminal angioplasty were 2 mild episodes of acute tubular necrosis, 1 extensive thigh and groin hematoma, and a small internal flap was raised by the percutaneous transluminal angioplasty catheter tip but no permanent damage resulted. This report shows that percutaneous translumirial angioplasty of renal transplant artery stenosis is a safe procedure, has less mortality and morbidity than an operation, and could improve renal allograft function and control blood pressure better. The authors consider percutaneous transluminal angioplasty as the procedure of choice for renal transplant artery stenosis. F. T. A. 3 figures, 21 references
Editorial comment. Although this mode of treatment of posttransplantation renal artery stenosis must be monitored carefully the success noted by most investigators is impressive. Since the surgical procedure necessary to correct such an abnormality often is most difficult in the transplant patient, the patients found to have renal artery stenosis should be individualized and strong consideration should be given to those lesions considered amenable to this type of transluminal dilation. G.D.F. Effect of Pretransplant Stored Donor-Specific Blood Transfusions on Early Renal Allograft Survival in One-Haplotype Living Related Transplants J. D. WHELCHEL, J. H. SHAW, J. J. CURTIS, R. G. LUKE AND A. G. DIETHELM, Departments of Surgery and Medicine, University of Alabama School of Medicine and University Hospital, Birmingham, Alabama Transplantation, 34: 326-329 (Dec.) 1982 The authors studied the effect of pre-transplant stored donorspecific blood transfusions on graft survival in 37 consecutive patients (group B) who received 1-haplotype-matched living related donor kidneys. This group of patients was compared to another group of 38 consecutive patients (group A) who also received 1-haplotype-matched living related donor kidneys but did not receive donor-specific blood transfusions. The results show that the graft survival at 3 and 6 months was 100 and 90 per cent in group B patients, and 68 per cent at 6 months in group A patients. There was no hyperacute rejection nor hepatitis observed in group B patients following donor-specific blood transfusions. It is the authors' experience that the use of pre-transplant stored donor-specific blood transfusions appeared to improve the early graft survival in recipients of 1haplotype living related donor kidneys. The administration of stored donor-specific blood transfusions is simple and easily monitored, and also is convenient to the donor and recipient. It did not appear to be harmful to the recipient. F. T. A. 2 figures, 2 tables, 10 references
TRANSPLANTATION
from 1 to 5 years after transplantation. The HLA-B matching was found to be more beneficial than the HLA-A. HLA matching appears to be more beneficial in male recipients, blood group A recipients and subjects not presensitized to antigens of the HLA system. Matching for HLA-A and B also significantly improved the survival of second grafts. The HLA matching has a better prognosis when the number of incompatible antigens is carried by the donor alone than when the number of antigens is shared by donor and recipient. Preliminary analysis in the influence of matching for the HLA-DR antigens on cadaver graft survival may prove to be beneficial. F. T. A. 5 figures, 2 tables, 12 references
Maximal Hydration During Anesthesia Increases Pulmonary Arterial Pressures and Improves Early Function of Human Renal Transplants M. CARLIER, J.-P. SQUIFFLET, Y. PIRSON, B. GRIBOMONT AND G. P. J. ALEXANDRE, Departments of Anesthesiology and Transplantation, Cliniques Universitaires Saint Luc, Brussels, Belgium Transplantation, 34: 201-204 (Oct.) 1982 From January 1, 1979 to December 1, 1980 the authors studied the effect of maximal hydration during operation in 120 primary human cadaver transplants. All patients had a Swan Ganz catheter placed to monitor peroperative pulmonary arterial pressures. These patients were divided into group 1 with pulmonary arterial pressure <20 mm. Hg and a diastolic pulmonary arterial pressure <15 mm. Hg, and group 2 with pulmonary arterial pressure >20 mm. Hg and a diastolic pulmonary arterial pressure > 15 mm. Hg at the time of removal of the vessel clamps. At the beginning of the operation pulmonary arterial pressure, cijastolic pulmonary arterial pressure and central venous pressure were higher in group 2. At the time of clamp release these pressures as well as systolic blood pressure were also higher in group 2. The frequency of postoperative acute tubular necrosis was 36 per cent in group 1, while only 6 per cent in group 2. This study emphasizes that the pulmonary arterial pressure levels should be increased to >20 mm. Hg by adequate hydration to improve immediate function of the graft and to avoid postoperative acute tubular necrosis. F. T. A. 4 tables, 16 references
Percutaneous Transluminal Angioplasty Treatment of Renal Transplant Artery Stenosis R. A. GROSSMAN, D. C. DAFOE, R. B. SHOENFELD, E. J. RING, G. K. McLEAN, J. A. 0LEAGA, D. B. FREIMAN, A. NAJI, L. J. PERLOFF AND C. F. BARKER, Departments of Surgery, Nephrology, and Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Transplantation, 34: 339-343 (Dec.) 1982 The incidence of renal transplant artery stenosis in renal allograft recipients is approximately 10 per cent. Renal transplant artery stenosis frequently causes hypertension and may decrease renal allograft function. Between June 1979 and May 1982, 241 renal transplants were performed at the authors' hospital. Because of increasing hypertension in 24 patients an arteriogram was performed and significant renal transplant artery stenosis was found in 17 patients (7 per cent). All 17 patients underwent percutaneous transluminal angioplasty. Of these 17 patients 15 were successful on angiographic analysis. Of these 15 successfully dilated patients 13 had long-term
allograft survival with decreased blood pressure after percutaneous transluminal angioplasty. After a mean followup of 67 weeks blood pressure was reduced from a systolic of 184 ± 24 mm. Hg before percutaneous transluminal angioplasty to 135 ± 15 mm. Hg after percutaneous transluminal angioplasty and from a diastolic of 115 -± 10 mm. Hg before percutaneous transluminal angioplasty to 87 ± 11 mm. Hg after percutaneous transluminal angioplasty. Followup angiography was performed on 9 patients about 61 weeks after percutaneous transluminal angioplasty and showed no evidence of recurrent renal transplant artery stenosis. The majority of patients continue to require antihypertensive drugs but less potent ones than before percutaneous transluminal angioplasty. The complications of percutaneous transluminal angioplasty were 2 mild episodes of acute tubular necrosis, 1 extensive thigh and groin hematoma, and a small internal flap was raised by the percutaneous transluminal angioplasty catheter tip but no permanent damage resulted. This report shows that percutaneous translumirial angioplasty of renal transplant artery stenosis is a safe procedure, has less mortality and morbidity than an operation, and could improve renal allograft function and control blood pressure better. The authors consider percutaneous transluminal angioplasty as the procedure of choice for renal transplant artery stenosis. F. T. A. 3 figures, 21 references
Editorial comment. Although this mode of treatment of posttransplantation renal artery stenosis must be monitored carefully the success noted by most investigators is impressive. Since the surgical procedure necessary to correct such an abnormality often is most difficult in the transplant patient, the patients found to have renal artery stenosis should be individualized and strong consideration should be given to those lesions considered amenable to this type of transluminal dilation. G.D.F. Effect of Pretransplant Stored Donor-Specific Blood Transfusions on Early Renal Allograft Survival in One-Haplotype Living Related Transplants J. D. WHELCHEL, J. H. SHAW, J. J. CURTIS, R. G. LUKE AND A. G. DIETHELM, Departments of Surgery and Medicine, University of Alabama School of Medicine and University Hospital, Birmingham, Alabama Transplantation, 34: 326-329 (Dec.) 1982 The authors studied the effect of pre-transplant stored donorspecific blood transfusions on graft survival in 37 consecutive patients (group B) who received 1-haplotype-matched living related donor kidneys. This group of patients was compared to another group of 38 consecutive patients (group A) who also received 1-haplotype-matched living related donor kidneys but did not receive donor-specific blood transfusions. The results show that the graft survival at 3 and 6 months was 100 and 90 per cent in group B patients, and 68 per cent at 6 months in group A patients. There was no hyperacute rejection nor hepatitis observed in group B patients following donor-specific blood transfusions. It is the authors' experience that the use of pre-transplant stored donor-specific blood transfusions appeared to improve the early graft survival in recipients of 1haplotype living related donor kidneys. The administration of stored donor-specific blood transfusions is simple and easily monitored, and also is convenient to the donor and recipient. It did not appear to be harmful to the recipient. F. T. A. 2 figures, 2 tables, 10 references