Clinical kidney transplants

Electrophysiologic and histological monitoring of MHC-matched and mismatched canine intestinal allografts

Intestinal transplantation (ITx) has potential applications for the treatment of short-bowel syndrome (SBS). A major obstacle to its clinical use is rejection, which may partly be overcome by major histocompatibility complex (MHC) matching. At present, it is impossible to predict accurately the early onset of rejection. The aim of this study was to assess the value of in vivo measurements of transepithelial potential difference (PD) for the determination of rejection in MHC-matched and -mismatched canine ITx. A heterotopic ITx was performed in MHC tissue-typed Beagle dogs. Two ileostomies were created for PD monitoring and histology. Via one ileostomy, a well-defined segment of the IT, was isolated by a double balloon catheter and the intraluminal PD was measured in reference to a subcutaneous electrode. The PD responses during perfusion of a theophylline solution (crypt cell stimulation, PD theophylline) and during perfusion of a glucose solution (villus cell stimulation, PD glucose) were assessed. The results of in vivo PD measurements were compared with simultaneously obtained histology specimens. Four groups of dogs were studied: group 1 (controls, n = 10) ileal autotransplants; group 2 (n = 6) ileal allotransplants, fully mismatched; group 3 (n = 3) ileal allotransplants, 1 haplotype identical; and group 4 (n = 5), ileal allotransplants, fully matched. No immunosuppression was given. All dogs of group 1 survived indefinitely and both PD and histology showed no abnormalities. In group 2, 3, and 4 the onset of histological changes related to rejection corresponded well with decreased PD responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Living related renal transplantation in Ireland: a sixteen year review

Between January 1972 and December 1987, a total of 777 transplants were performed of which 135 (17%) were living related. There were 108 sibling donors, 25 parent to child and 2 child to parent. All sibling transplants were HLA identical. Conventional immunosuppression with Prednisone and Azathioprine was used in all cases. Actuarial patient survival were 95%, 91% and 88% at 1, 5 and 10 years respectively. Corresponding actuarial graft survivals were 90%, 80% and 60%. Graft survival in the sibling compared to the parent to child group was 87% versus 60% at 5 years. There were 13 deaths during the study interval and 32 grafts were lost. Five year patient/graft survivals of 91/80% compare favourably with other reported series. The poorer outcome in parent to child transplants has led us to modify the immunosuppressive protocol to include Cyclosporin A in this group. The increased availability and improved survival of cadaveric grafts in recent years and our one year patient/graft survival of 92/88% has led us to reduce emphasis on living related transplantation in our renal replacement programme.

The recent U.S. experience in the treatment of end-stage renal disease by dialysis and transplantation

We determined survival rates and rates of graft retention for patients who had begun to receive dialysis or had received transplants between January 1, 1977, and December 31, 1980, using the data collected by the Medical Information System of the Health Care Financing Administration, which covers nearly all persons with end-stage renal disease in the United States. We found that among patients receiving transplants in successive years in the period from 1977 to 1980 the rates of graft retention showed progressive and substantial increases, whereas survival rates for both dialysis and transplant recipients remained stable. In addition, we found that transplant recipients were subject initially to high risks of graft loss and death, but that these risks decreased rapidly in the few months after transplantation. The population receiving dialysis was subject to a nearly constant death rate, which was generally higher than the stable late-mortality rate among transplant recipients. Blacks had higher survival rates than whites on dialysis, black and white patients had similar survival rates after transplantation, and black patients had lower rates of retention of functioning grafts. Finally, our analysis indicates that the best results were obtained in recipients of kidneys from related donors.