Kidney transplantations at King Faisal Specialist Hospital and Research Centre

During the five year period from 1987G to 1991G, 161 kidney transplantations were performed at King Faisal Specialist Hospital and Research Centre (KFSH&RC); 79 from cadaveric donors (CD) and 82 from living related donors (LRD). All cadaveric kidneys except one were harvested within Saudi Arabia and 67% were from Saudi nationals. The immunosuppresive protocol was a triple drug regimen comprising cyclosporin-A (CyA), azathioprine (Aza), and prednisone. The actuarial graft survival rates at one and three years were 85% and 76% for the cadaveric donor transplants and 96% and 91%, respectively for the living related donor transplants (P<0.01). The corresponding patient survival rates for cadaveric donor transplants (CDTxs) were 97% and 94% and for the living related donor transplants (LRDTxs), 99% and 97% (NS). These results compare well with the best results in the Western world. The most serious surgical complications were vascular thromboses (five cases) and infections of the arterial anastomosis line with bleeding (two cases), all leading to loss of the cadaveric graft. The most common causes of death were virus infection, varicella, cytomegalovirus, and hepatitis B and C. The organ donation rate, from cadaveric donors as well as living related donors, is stil low in Saudi Arabia. Lack of organs is the main obstacle to an expansion of this promising transplantation activity. Continuous education of the multinational medical profession as well as the lay population is necessary to improve the situation.

Successful outcome of segmental human pancreatic transplantation with enteric exocrine diversion after modifications in technique

Segmental pancreatic transplantation is now the most widely favoured form of pancreatic transplantation, but the major difficulty with this procedure is the handling of the exocrine secretion. The use of a pancreaticoenteric anastomosis for exocrine diversion has been re-evaluated and several ancillary measures to reduce the risk of fistula and bacterial contamination have been applied. In three consecutive patients there have been no complications related to the exocrine pancreas. The pancreatic and renal grafts of these patients are functioning well 7, 3, and 2 months, respectively, after transplantation.

Metabolism of carbamazepine and its epoxide metabolite in human and rat liver in vitro

The epoxidation of carbamazepine (CBZ) and the hydration of the primary epoxide metabolite was studied in microsomes isolated from ten human livers. To study the epoxide hydrolase activity a high-performance liquid-chromatographic method was developed for the analysis of dihydro-CBZ-trans-diol. There was a pronounced variation between the specimens in the activity of both enzymes. There appeared to be a positive correlation between the activity of the two enzymes. In rats pretreated with either CBZ or phenobarbital for 4 days, the microsomal epoxidation of CBZ was induced. The epoxide hydrolase activity was also increased, although less so than in epoxidation.

Reduced steroid doses in cadaveric renal transplantation

Commencing 1978, we reduced the initial dose of prednisolone to 40 mg/day against a former 120-200 mg/day for cadaver kidney recipients aged 60 years and above. The patient and graft survivals at 1 year which earlier had been 59 and 47% is 69 and 46% after the change (NS). From August 1980, we reduced the initial prednisolone dose to 30 mg/day for all recipients of cadaver kidneys. From the same time, all patients were given 5 units of leukocyte poor blood prior to the transplantation, and in addition, RATG (Stanford) was given during 2 weeks immediately following the transplantation. Preceding the reduction the patient and graft survivals at 6 months were 91 and 62% while they were 88 and 88% after the reduction (NS). The intravenous dose of methylprednisolone, which is used for the treatment of acute rejection, was reduced twice in this period, first from 6 to 3 g, and then to 1.75 g total dose. The proportion of rejections, successfully treated, had remained unchanged. Our preliminary results support the notion that it is possible to use lower steroid doses than previously in conjunction with cadaveric kidney transplantations. However, we have introduced other alterations of the routines which could have influenced the results.

Further experience with antihuman lymphocyte globulin (Behring): no effect on cadaveric renal graft survival

In 1977 we reported that 1 year cadaveric renal graft survival was improved in patients treated with high dose anti-human lymphocyte globulin (AHLG) (Behring). Such a beneficial effect of this agent was not confirmed in the present study with an enlarged series of patients and with a longer follow-up time. Nor was there any gain in respect of renal function or any steroid sparing effect. The only indication of an immunosuppressive effect is that the rejection episodes possibly occurred later in the patients given the high dose AHLG.

Attempt at enzyme replacement in Gaucher disease by renal transplantation

In Gaucher disease there is a deficiency of the lysosomal enzyme, cerebroside-beta-glucosidase, as a result of which cerebroside (glucosylcereamide) accumulates in various organs. In northern Sweden 22 patients with a juvenile form of this disease have been identified. In one such patient, a girl of 10 years, we have attempted enzyme replacement by renal transplantation. After this operation the hepatic glucocerebroside content fell significantly. In another child afflicted with Gaucher disease in whom splenectomy was performed for severe splenomegaly and hypersplenism there was a progressive increase in the level of this lipid. These findings suggest that enzyme replacement was achieved by transplantation of a normal organ.

Attempt at enzyme replacement by organ transplantation: renal transplantation in Gaucher disease

Following renal transplantation, hepatic glucocerebroside deposits in a child with Gaucher disease were reduced. This suggests that enzyme replacement had been achieved.

Rejection of isolated pancreatic allografts in patients with with diabetes

Four patients with diabetes mellitus of juvenile onset but without uremia have been treated with segmental transplantation of the body and tail of pancreas. The indications were hyperlabile diabetes or progressive loss of vision. The grafts were procured from cadaveric donors four to 16 minutes after circulary arrest and were subsequently stored in the cold for approximately four hours. In one patient, the pancreatic duct was ligated, while in the other three, drainage was attained by suturing the transected end of the pancreas into a jejunal Roux-en-Y loop. Three of the grafts failed within six weeks as a result of irreversible refection, and one graft failed because of the early onset of venous thrombosis. The first sign of graft rejection was an increase in the postprandial blood sugar level, an increase in the fasting blood sugar level occurring several days later. Neither hyperamylasemia nor fever was observed. Radioisotope scans and angiograms were of great value in establishing the diagnosis of graft rejection. All of the patients survived after graft removal.