Renal transplantation in children.

23 children aged 1--16 years of age have received renal transplantation during the years 1972-1975 at the Downstate Medical Center. Of 9 children transplanted from related donors, I died and 3 lost their kidney-2 were retransplanted; 1 lost the second graft. Of 14 children transplanted from cadaver donors, 2 died, and 3 lost their kidney.

Patient self-referral for kidney transplantation.

A total of 634 patients referred for transplantation was followed for up to 5 yrs, 149 being self-referred and 485 being referred by their physicians. The survival rates of those transplanted in both groups were compared to those not transplanted. The self-referred group increased their chances of receiving a transplant by 20% and did not increase their risk of mortality.

Effects of intravenous bolus dosages of methylprednisolone and local radiation on renal allograft rejection and patient mortality.

One hundred and thirty of 179 rejection episodes encountered in 205 transplants were reversed by treatment with a bolus preparation of methylprednisolone. Ninety-six of these episodes also required an increase in oral prednisone dosage. No beneficial effect on over-all graft survival was noted, but a significant rise in the mortality, secondary to sepsis, was noted in those who received more than 5 grams of methylprednisolone.

Prolonged epicardial mapping in myocardial infarction: the effects of propranolol and intra-aortic balloon pumping following coronary artery occlusion.

A methods of prolonged epicardial surface mapping of myocardial infarction by serial epicardial ECG's is described. The progression of infarction following coronary artery ligation in dogs was monitored over a 4 day period and the early and late changes in the configuration of the epicardial ECG's associated with the underlying myocardial injury were defined. The determination of the infarct size by surface mapping in vivo correlated accurately with the final infarct size determined by dehydrogenase staining in vitro.

Renal transplantation in patients with posterior urethral valves.

Abnormalities of the lower urinary tract are relative contraindications for kidney transplantation that have been overcome by corrective operations or construction of conduits. In our 2 patients with posterior urethral valves and defunctionalized lower urinary tracts kidney transplantation with ureteroneocystostomy and later resection of the valves resulted in satisfactory bladder function and normal voiding patterns. Therefore, urinary diversion was completely avoided.

Renal artery stenosis in renal transplant recipients.

Of 13 patients with severe post-transplant hypertension, in 11 (85%) the hypertension was secondary to TRAS. Surgical correction of arterial stenosis reversed renal failure in 2 patients and cured or improved hypertension in 9 patients. Renin levels from TRV was normal in patients studied and was not useful in predicting surgical success.

Relationship of renal transplantation to hypertension in chronic renal failure.

Hypertension is prevalent in 49% of renal transplant recipients. Chronic rejection and impaired renal function may account for mild to moderate hypertension in most patients. The development of severe hypertension following renal transplantation, however, suggests TRAS, which is amenable to surgical correction with a high probability of success.

A new vascular access for hemodialysis: the arterial jump graft.

In seven patients in whom conventional vascular access for maintenance hemodialysis was not possible, a new access in the form of a femoropopliteal jump graft was employed. A follow-up of 3 months to 3 years (92 patient months) and an experience of more than 1,000 dialysis treatments have shown it to be a stable and satisfactory access.

Clinical study of second kidney transplantation.

During the period from November 1972 to February 1975, 39 patients received second renal grafts in our institution. The clinical course of the patients was analyzed and compared with 121 patients who received only one graft during the same period. The graft survival either from living related or cadaveric sources was inferior in the second graft group.

Elective and emergency surgery in renal transplant patients.

Additional operations were necessary in 67 (41%) of 162 renal allograft patients. General anesthesia was employed in all but 5 patients with no morbidity or mortality. All patients were immunosuppressed and no additional steroids were used before, during, or after the procedure.

Urologic complications in renal primary and retransplantation. Experience with 202 consecutive transplants.

In a period of two years, 202 kidneys were transplanted in 162 patients at the Downstate Medical Center. On hundred twenty-nine patients had primary transplantations, twenty-nine second transplantations, and five third transplantations. Urologic complications occurred in twenty-four of the patients (12%).

Nephrolithiasis and nephrocalcinosis after renal transplantation: a case report and review of the literature.

Stone formation in renal allografts is rare. Although infection or renal tubular acidosis can predispose to calcium deposition in a renal allograft, hyperparathyroidism is usually an accompanying factor. Parathyroidectomy is recommended as the treatment of choice when stone deposition or nephrocalcinosis occurs after transplantation.

Vascular complications in human renal transplantation.

There were 13 arterial complications in 202 transplants done in 162 patients, an incidence of 6.5 percent. Renal arterial stenosis was demonstrated by angiogram in six kidneys; four were reconstructed successfully.

Transplant nephrectomy and simultaneous second graft retransplantation.

Tranplant nephrectomy and retransplantation has become an established modality in treating patients with rejected kidney allografts. Experience with 29 patients who underwent simultaneous transplant nephrectomy and retransplantation is presented. This procedure did not involve a considerably greater risk than a primary transplant and had an almost equal rate of success.

Arterialization of the liver in combination with a portacaval shunt in the dog.

A dog preparation has been developed combining an end-to-side portacaval shunt with arterialization of the hepatic portion of the portal vein through an anastomosis between the inferior branch of the splenic artery and the stump of the portal vein. In this dog preparation, total hepatic blood flow, perfusion of the intrahepatic portal vein, and sinusoidal pressure remained within the preoperative range in the majority of the dogs. The data presented indicate that arterialization of the liver, under those conditions, resulted in no histologic damage or atrophy of the parenchyma of the liver and was effective in achieving significant prolongation of life and prevention of most of the adverse metabolic sequelae that follow a portacaval shunt in dogs.

Continuous single pass perfusion of the isolated kidney.

The use of continuous single pass perfusion to study the metabolism of isolated kidneys reveals that active metabolic processes continue in the hypothermically preserved kidney. These preliminary experiments described demonstrated a rapid uptake of substrates from the perfusion media in the first 24 hrs of storage, followed by a release of organic acids in the subsequent 24 to 72 hrs. Urea was found to be easily eliminated from the kidney.