Timing of cyclosporine administration in patients with delayed graft function.

Cyclosporine in renal transplant recipients with delayed graft function (DGF) has been reported to decrease graft survival and prolong both DGF and hospitalization. In some centers, antilymphocyte globulin (ALG) has been used perioperatively to obviate these problems, but ALG is associated with increased viral infections. In this study, first cadaver transplant recipients with a fall in serum creatinine level of greater than or equal to 30% in the first 24 hr were started on prednisone (P) and cyclosporine (Group 1, n = 18).

Recurrent membranoproliferative glomerulonephritis type 1 in successive renal transplants.

We report a man who developed renal failure due to membranoproliferative glomerulonephritis (MPGN) type 1 which recurred in two cadaveric kidney transplants. This is the third such case in the literature. Nephrotic syndrome developed within 1 month following transplantation and histologic evidence of disease recurrence was documented in both kidneys 2 months after transplantation.

Transplantation of pediatric donor kidneys to adult recipients. Is there a critical donor age?

Cadaver kidneys remain a scarce resource, yet single pediatric donor kidneys are underutilized at some centers. Between 1967 and 1984, 133 single pediatric and 318 adult donor cadaver transplants were performed. Patient and graft survival, renal function, and complications in adult recipients grouped by donor age were compared.

ALG treatment of steroid-resistant rejection in patients receiving cyclosporine.

Thirty-one episodes of biopsy-proved acute rejection (R) in 28 patients maintained on cyclosporine did not respond to high-dose steroids and were treated with antilymphocyte globulin (ALG). Cyclosporine was discontinued in all but three during ALG administration. (A) Twenty-four patients received 26 courses of ALG within 90 days of transplant (11 1st R, 15 2nd or 3rd).

Definition, diagnosis, and management of rejection in the second to sixth months posttransplant--an overview.

CsA immunosuppression has resulted in decreased graft loss from rejection. However, rejection episodes do occur and, in fact, rejection remains as the major cause of graft loss in the CsA-treated patient. CsA, itself, has added to the differential diagnosis of renal dysfunction following transplantation.

The value of needle renal allograft biopsy. III. A prospective study.

Previous studies of the value of percutaneous renal transplant biopsy have been retrospective. We prospectively studied whether biopsy affected patient management. Thirty-five patients with elevated serum creatinine level underwent 44 biopsies in situations in which the diagnosis was in doubt.

Treatment of renal transplant rejection episodes in patients receiving prednisone and azathioprine. A cost-effective approach.

Antilymphocyte globulin (ALG) has been advocated for the treatment of renal transplant rejection episodes in patients maintained on prednisone and azathioprine. Treatment with steroids (outpatient) is considerably less expensive than with ALG (inpatient), so we studied whether routine ALG was necessary. Between 3/82 and 11/83, 54 cadaver transplant recipients maintained on prednisone and azathioprine who developed a first rejection episode were randomized to receive--for treatment of their first, and if necessary second, rejection--methylprednisolone (MP) plus ALG (n = 24), or MP alone, with ALG added if treatment failed (n = 30).

A proposal for cadaver organ procurement: routine removal with right of informed refusal.

In order to alleviate the shortage of vital organs for transplant, we propose a system of routine removal of cadaver organs with an option of informed refusal by family. Unless an individual registered an objection during his or her lifetime, or unless the family objected to the procedure, clinicians would be permitted routinely to salvage vital organs for transplant. Our proposal charts a middle path between the current ineffective policy based on "encouraged voluntarism" and "presumed consent" policies that promise effectiveness at the cost of violating traditional ethical and legal principles.

Association of concurrent herpes simplex virus and cytomegalovirus with detrimental effects after renal transplantation.

Herpes simplex virus (HSV) and cytomegalovirus (CMV) infections occur frequently after renal transplantation. To determine the effect of these infections on long-term prognosis, we reviewed the charts of 558 patients who underwent primary renal transplantation between Jan 1, 1974 and Dec 31, 1978, at the University of Minnesota Hospitals, Minneapolis, for cultural evidence of these infections. The presence of HSV alone appeared to have a minimal effect on either patient or allograft survival.

The fate of the patient returned to hemodialysis after losing a renal transplant.

Previous reports have suggested that renal allograft recipients have an increased mortality rate when returned to hemodialysis. We studied the survival of patients returned to hemodialysis after losing a renal allograft and compared it with the survival of patients undergoing maintenance hemodialysis during the same period as reported by individual centers in the United States and by the European Dialysis and Transplant Association. Six-year actuarial survival of 83 patients after loss of a first transplant and of 37 patients after loss of two or more transplants compared favorably with data on survival of patients undergoing maintenance dialysis.

Successful long-term cryopreservation of neonatal rat islet tissue.

Neonatal rat pancreatic tissue was frozen to -196 degrees C using Me2SO as a cryoprotectant and a slow freezing rate to -70 degrees C followed by immersion in liquid nitrogen. Rapid thawing was used. Viability was demonstrated by successful transplantation to streptozotocin-induced diabetic recipients.

The value of needle renal allograft biopsy. I. A retrospective study of biopsies performed during putative rejection episodes.

Following renal transplantation, immunosuppression is usually increased to treat presumed rejection episodes. However, a) many conditions mimic rejection in the post-transplant period, and b) many rejection episodes are irreversible. As increased immunosuppressive therapy is associated with an increased risk of infection, it would be ideal to limit antirejection therapy to only the rejection episodes that are reversible.