Anesthetic protocol in human renal transplantation: twenty-two years of experience.

This paper reviews the experience of 22 years of transplantation. From June 1963 to December 1984, 1362 human renal grafts were performed in our center. Throughout this period, advances in surgical techniques, kidney preservation methods and immunosuppressive regimen have improved patient and graft survival.

Six human pancreas transplants: results and perioperative management.

Satisfactory results were obtained in 5 type I diabetic recipients of 6 human pancreas transplantations. We chose the three following options: diversion of the pancreatic juice by a pancreaticojejunostomy, simultaneous kidney transplantation from the same donor and cyclosporin A as the basic drug in the immunosuppressive regimen. Further conclusions were also drawn from our experience.

[Kidney transplantation in a case of amyloidosis].

Renal transplantation was performed in five patients with various forms of amyloidosis (familial amyloidosis, Mediterranean fever and Crohn's disease). All grafts were functioning one year after the operation. Only one patient died of cardiac shock more than 10 years after transplantation; the other recipients are alive with a functioning graft from 12 to 67 (mean, 41) months after transplantation.

Current status of clinical pancreas transplantation.

Pancreas transplantation (PT) has become increasingly effective for the treatment of human diabetes. Islet transplants have been successful only in the laboratory; clinical human islet transplantation needs to be improved with a search to reduce islet cells immunogenicity. Up to now, the only effective method of endocrine replacement therapy in diabetic patients is vascularized pancreas transplantation.

Cyclosporin A efficacy and toxicity in organ transplantation with special focus on cadaveric renal transplantation.

The pharmacodynamic and pharmacokinetic properties of cyclosporin A are reviewed. Its adverse reactions and posology in allograft transplantation are described according to clinical experience. Preliminary results with the use of cyclosporin A (Cy A) in primary cadaveric renal transplant patients, in comparison to 3 other conventional treatments, are reported in a randomized study of 69 patients: even if graft acute tubular necrosis is more frequent in the Cy A group, this group is the one which reaches the most successful short term renal graft survival.

[Non-traumatic rupture of the Achilles tendon after renal transplantation].

Two renal transplant recipients who had been grafted for 6 and 17 years respectively and whose transplants were perfectly well tolerated presented with non traumatic rupture of Achilles tendon. A few days to a few weeks previously, they had experienced pain in the Achilles tendons of both legs. No sign of so-called systemic disease or hyperparathyroidism was present.

Late urinary tract infection after transplantation: prevalence, predisposition and morbidity.

We have evaluated the incidence, prevalence, predisposing factors and evolution of urinary tract infection (UTI) developing late after transplantation in 63 patients whose graft had lasted at least 3 months and whose follow-up averaged 7 years. Beyond 3 months after transplantation incidence of UTI decreases progressively, from 25 to 0%, 50% of the patients remaining free of infection throughout the period of observation. Neither the original kidney disease except perhaps diabetic nephropathy nor the presence of vesicoureteral reflux were predisposing factors.

Aetiology and prognosis of de novo graft membranous nephropathy.

In order to investigate the aetiology and prognosis of de novo graft membranous nephropathy (DNGMN), we review 25 such cases observed among 1258 grafts. Coexistence of chronic rejection lesions and their parallel progression with DNGMN suggest that DNGMN may be part of the rejection process. DNGMN developed in 12 per cent of HLA-identical living donor recipients vs only two per cent of both haplo-identical and cadaver donor recipients; in the latter group, all DNGMN patients had less than or equal to 2 HLA-AB mismatches.

Dermal alternariasis in a kidney transplant recipient.

Dermal alternariasis represents one of the new infectious diseases related to immunodepression, especially in kidney recipients. Periodic acid-Schiff and Grocott stains of paraffin sections and mycological cultures must be resorted to in order to establish the diagnosis. Ketoconazole should be the best treatment.

Mycotic aneurysm of renal graft artery: diagnosis by ultrasonography.

Mycotic aneurysm of the renal graft artery is rarely detected before its rupture. Diagnosis up to now relied on arteriography. We report on a patient whose preoperative diagnosis was made by ultrasonography.

[Lymphoceles after renal transplantation].

Lymphocele following renal transplantation occurs in 1 to 10 p. cent of cases. Pathogenesis and symptomatology are discussed, based on findings in 8 cases.

[Importance of continuous positive pressure ventilation in kidney transplantation: a pilot study].

Continuous positive airway pressure ventilation (CPAP) tends to reduce the risk of post-operative pulmonary infection by recruiting poorly ventilated areas. In human renal transplantation, pulmonary infection is a major problem with a high mortality rate in these immuno-depressed patients. The risk is further increased by the need for recipient maximal hydration during surgery to ensure satisfactory graft function.

Prevalence and causes of hypertension late after renal transplantation.

We analysed the prevalence and causes of hypertension in 77 patients followed greater than or equal to 7 years after renal transplantation. Prevalence of hypertension remains stable, around 55 per cent, up to 11 years post-transplant. Age, sex, type of original nephropathy, graft source or prednisolone dosage are not related to hypertension; body weight is greater in hypertensive patients.

Haemodialysis or renal transplantation in the treatment of end-stage diabetic nephropathy.

We have reviewed 27 diabetic patients treated between 1971 and 1981 by haemodialysis and/or by transplantation. Overall patient survival is 43 per cent at five years (vs 78 per cent in non-diabetics of similar age). Two year patient survival is identical (73%) with haemodialysis and after transplantation.