The fate of failed renal homografts retained after retransplantation

The fate of nonfunctioning or poorly functioning renal homografts which were left in situ at retransplantation was studied in 28 patients. In one recipient, lethal septicemia developed secondary to necrosis as well as infection of a retained intraabdominal graft. In three other patients, subsequent symptoms developed from retained extraperitoneal pelvic grafts, and these kidneys were removed without complication. It is suggested that grafts placed extraperitoneally can be left in place if retransplantation becomes necessary, provided that there is careful follow up study for signs of necrosis or infection. Removal of the kidney graft then may be performed electively at a later time, or this may never become necessary in a significant number of patients

Acute effect of prednisolone on renal handling of sodium.

The effect of prednisolone on renal handling of sodium (Na) was studied in rats under three experimental conditions: 1) hydropenia, 2) water diuresis, and 3) distal tubular blockade (DTB). Prednisolone, 0.25 mg/100 g per hr, was infused directly into left renal artery and urine was collected separately from each kidney. Predominantly unilateral increases in urine flow (V) and Na excretion were noticed in all experiments during prednisolone infusion. In the hydropenic rats the maximal increments on the infused side were, for V (mean ± SD), from 9.3 ± 1.5 to 21.4 ± 0.8 μl/min (P < 0.001); for C(Na)/C(In), from 0.28 ± 0.11 to 2.97 ± 0.71 % (P < 0.005); and for [Formula: see text] , from 2.93 ± 2.26 to 5.32 ± 1.92% (P < 0.05). In the rats with water diuresis, the maximal increases were, for V/C(In), from 5.87 ± 1.97 to 10.1 ± 6.0% (P < 0.005); for C(H(2)O)/C(In), from 4.09 ± 0.68 to 6.00 ± 0.44% (P < 0.0005); and for C(Na)/C(In), from 0.22 ± 0.07 to 0.70 ± 0.38% (P < 0.01). In DTB-rats the maximal increases were for V from 48.6 ± 9.0 to 72.7 ± 14.1 μl/min (P < 0.0005) and for C(Na)/C(In) from 9.42 ± 2.97 to 20.23 ± 7.34% (P < 0.005). In the contralateral kidney these changes were less pronounced. These observations suggest that prednisolone depresses directly Na reabsorption. The association of natriuresis with augmented [Formula: see text] and C(H(2)O)/C(In) during hydropenia and water diuresis, respectively, and the increases in V and C(Na)/C(In) during DTB, all are consistent with inhibition of Na reabsorption in the proximal tubule

Thoracic duct drainage in organ transplantation: Will it permit better immunosuppression?

It is possible that thoracic-duct drainage, a major but neglected immunosuppressive adjunct, can have an important impact on organ transplantation. If thoracic-duct drainage is started at the time of transplantation, the practicality of its use in cadaveric cases is greatly enhanced. With kidney transplantation, the penalty of not having pretreatment for the first organ is compensanted by the automatic presence of pretreatment if rejection is not controlled and retransplantation becomes necessary. The advantage of adding thoracic-duct drainage to conventional immunosuppression may greatly enhance the expectations for the transplantation of extrarenal organs, such as the liver, pancreas, heart, and lung. There is evidence that pretreatment with thoracic-duct drainage of patients with cytotoxic antibodies may permit successful renal transplantation under these otherwise essentially hopeless conditions. Exploration of the neglected but potentially valuable tool of thoracic-duct drainage seems to the authors to be highly justified in other centers

LIVER TRANSPLANTATION IN MAN

Until quite recently it was possible to give only highly tentative opinions on the role of liver transplantation in the treatment of patients dying of incurable liver disease. Now, a much more authoritative position concerning clinical liver transplantation can be taken, since there have been six patients who have lived for more than a year after removal of their own diseased livers and replacement with cadaveric organs. The mortality has been high, just as it was in the first trials with renal transplantation. Nevertheless, we believe that the future role of liver transplantation in hepatic disease will not be fundamentally different than cadaveric kidney transplantation in the field of renal disease. In this paper we will give the justification for this optimistic view, mention the indications for such operations as they have become clear in the last year and, above all, focus attention upon the errors in technique or judgment we have made which have accounted for most of the early deaths in our experience