Pattern of oculomotor and visual function in children with hydrocephalus.

PURPOSE: To investigate the ocular motility disturbances, optic nerve changes, and refractive errors in children with or without surgically treated hydrocephalus. METHODS: This retrospective study included 63 subjects diagnosed with hydrocephalus between 2007 and 2019 at the Baskent University Hospital. Full orthoptic and ophthalmic examination and brain magnetic resonance imaging were performed in all subjects. RESULTS: The mean age of patients was 68.4±27.6 months, and the mean follow-up time was 21.3±5.2 months. Twenty-one (51.2%) patients had esotropia (ET), and 14 (34.1%) had exotropia (XT). Of the patients with ET, 9 (14.2%) had a sixth nerve palsy. Four patients (6.3%) had a fourth nerve palsy, and 1 had a superior rectus palsy. Eleven patients had manifest, and 2 latent, nystagmus. Thirteen (20.6%) patients had optic disc abnormalities. The mean BCVA was 0.4±0.2 (0.05-1.0) in the right eye and 0.5±0.2 (0.1-1.0) in the left eye. Of the 19 (30.1%) patients who had a significant refractive error, 9 (47.3%) had hyperopia. Thirty-six (57.1%) patients had ventriculoperitoneal shunt surgery, and 11 (30.5%) of them had shunt revision due to occlusion. Ocular motility disorders were found to be significantly more common in patients who underwent single shunt surgery and shunt revision than those who had no surgical procedure (P=0.041and P=0.032, respectively). CONCLUSION: The evaluation of ocular motility disorders and visual dysfunction in hydrocephalic children can be a source of valuable information when diagnosing and following the disease.

Long-Term Follow-up Results of Renal Transplantation in Pediatric Patients With Focal Segmental Glomerulosclerosis: A Single-Center Experience.

INTRODUCTION AND AIM: Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease in children. We analyzed the long-term outcome of pediatric patients with FSGS undergoing renal transplantation. The objective of the study is to report the experience of a single center and determine the incidence of recurrence, rejection, graft loss, and related risk factors. MATERIALS AND METHOD: This retrospective cohort study was performed between 1991 and 2018. Thirty patients with a pathologic diagnosis of primary FSGS were included in the study. The patients were diagnosed with FSGS according to histologic features in biopsies. RESULTS: Twenty-one of the donors were deceased (70%) and 9 were alive (30%). FSGS recurred in only 2 patients. Graft loss occurred in 6 patients (20%). The causes of graft loss were chronic rejection in 4 patients and acute rejection in 2. Our graft survival rate was 100% at 1 year, 91% at 5 years, 80% at 10 years, 70% at 15 years, and 42% at 20 years. Five- and 10-year graft survival rates were 83% and 83% in living donors and 94% and 79% in deceased donors, respectively. According to Kaplan-Meier analysis, there was no statistically significant difference in terms of graft survival between living and deceased donors. CONCLUSION: This study, with its contribution to literature in terms of long follow-up of FSGS patients from childhood to adulthood, is important. However, further studies are required.

Efficacy and Safety of ATG-Fresenius as an Induction Agent in Living-Donor Kidney Transplantation.

BACKGROUND: Induction therapy is mostly recommended for deceased-donor transplantation, whereas it has some controversies in live-donor transplantation. In this study, we described the outcomes of live-donor renal transplant recipients who received ATG-Fresenius (ATG-F) induction. METHODS: Live-donor transplantations in patients over 18 years old with ATG-F induction between 2009 and 2015 were included. All patients received quadruple immunosuppression, one of which was ATG-F induction. Biopsies after the artery anastomosis (zero hour) and protocol biopsies at the 6th month and at the 1st first year were obtained. Acute graft dysfunction was defined as a 20% to 25% increase in creatinine level from baseline. All acute rejection episodes were biopsy-confirmed. All episodes were initially treated with intravenous methyl prednisolone (MP) or ATG-F if resistant to MP. Four hundred twenty-two patients with live-donor transplantation were evaluated. The mean age was 40 ± 13 (18-73) years. The mean panel-reactive antibody levels were 42% ± 30% and 45% ± 30% for class I and II, respectively. RESULTS: The mean mismatch number for living unrelated donors (n = 112) was 4.6 ± 1.0. Acute rejection rate was 29.1% (123 patients) within the first year. The mean cumulative ATG-F doses for per patient and per kilogram were 344 ± 217 mg and 5.1 ± 2.7 mg, respectively. Patient survival rates were 98.3% and 96.7% for 12 months and 60 months, respectively. Death-censored graft survival rates were 97.6% and 92.1% for 12 months and 60 months, respectively. CONCLUSIONS: ATG-F induction provided excellent graft and patient survival rates without any significantly increased side effects. Increasing sensitized patient numbers, more unrelated donors, increasing re-transplantation numbers, and more desensitization protocols make ATG-F more favorable in an induction regimen.

Use of ATG-Fresenius as an Induction Agent in Deceased-Donor Kidney Transplantation.

BACKGROUND: Anti-T-lymphocyte globulins (ATG) are most commonly used as induction agents in kidney transplantation (KT). In this study, we investigated the use of ATG as induction therapy in deceased-donor KT. METHODS: Among 152 deceased-donor KT recipients transplanted between January 2009 and December 2003, 147 with exact data were enrolled in this study. Delayed graft function was defined as dialysis requirement after KT. Greater than 10% panel-reactive antibody (PRA) was considered as positive. Total ATG (rATG-Fresenius) dosage and induction duration was evaluated. Mean age was 45 ± 10 years; 91 patients were male and 56 patients were female. Class I and class II PRA-positive patient numbers were 20 (13.6%) and 17 (11.5%), respectively. Pre-transplant dialysis vintage was 108 ± 63 months. Mean donor age was 42 ± 17, and cold ischemia time was 16 ± 5 hours. Eighty-nine patients (60%) had delayed graft function and needed at least one session of hemodialysis after transplantation. Cumulative ATG-F dosage was 676 ± 274 mg. The mean ATG-F cumulative dosage was 10.6 ± 3.8 mg/kg. At the end of first year, mean creatinine and proteinuria levels were 1.4 ± 1.0 mg/dL and 0.3 ± 0.4 g/d, respectively. RESULTS: Mean follow-up time was 32 ± 20 months. During follow-up, there were 14 graft failures and 11 patients died. Patient survival for 1 and 2 years were 93% and 92.3%, respectively. Death-censored graft survival rates for 1 and 2 years were 94.8% and 90.8%, respectively. CONCLUSIONS: ATG-F induction provides acceptable graft and patient survival in deceased-donor KT. ATG-F infusion is well tolerated. Infection rates seem to be acceptable compared with all transplantation populations.

Unenhanced respiratory-navigated NATIVE® TrueFISP magnetic resonance angiography in the evaluation of renal arteries: Comparison with contrast-enhanced magnetic resonance angiography.

PURPOSE: To compare unenhanced three-dimensional (3D) NATIVE® true fast imaging with steady-state precession (TrueFISP) magnetic resonance (MR) angiography with the more conventional MR angiography technique obtained after intravenous administration of a gadolinium chelate in the evaluation of renal arteries and their branches in patients with suspected renal artery stenosis. MATERIALS AND METHODS: A total of 39 patients (25 men, 14 women) with a mean age of 51.4±17.5years (SD) (range: 10-82years) were included in the study. All patients with suspected renal artery stenosis underwent unenhanced 3D NATIVE® TrueFISP MR angiography and contrast-enhanced MR angiography. The two MR angiography methods were compared by two independent readers for image quality using a four-point scale, diagnostic performance and grading of renal artery stenosis on a total of 78 renal arteries. RESULTS: For both readers image quality of unenhanced 3D NATIVE® TrueFISP MR angiography (3.12 to 3.63) was greater than that of contrast-enhanced MR angiography (1.94 to 2.71) for renal artery ostium-trunk and the left renal artery segmental branches. The sensitivity of 3D NATIVE® TrueFISP MR angiography for the diagnosis of renal artery stenosis was 100% for both readers for the right renal artery and 66% and 80% for the left renal artery for reader 1 and reader 2, respectively. Agreement between 3D NATIVE® TrueFISP MR angiography and CE-MR angiography was 95% (74/78) for reader 1 and 92% (72/78) for reader 2. CONCLUSION: Unenhanced NATIVE® TrueFISP magnetic resonance angiography can play an additional role in the evaluation of renal arteries in patients with hypertension, especially in subjects at risk of nephrogenic systemic fibrosis.

Is a High Body Mass Index Still a Risk Factor for Complications of Donor Nephrectomy?

BACKGROUND AND AIM: The incidence of obesity is increasing all around the world and Turkey is no exception. In Turkey, 80.1% of all kidney transplants performed in 2013 were living donor kidney transplants. In this study we compare the early postoperative complications of living kidney donors with a body mass index (BMI) over 30 to those with BMIs under 30. PATIENTS AND METHOD: All donor nephrectomies performed at the Ege University School of Medicine Hospital between May 2013 and May 2014 were included in the study. Donors' demographics, preoperative BMI, operation time, length of hospital stay, postoperative complications, and perioperative blood creatinine levels were analyzed. RESULTS: There were a total of 72 donors, 50 of whom had a BMI below 30 (group 1), whereas 22 had a BMI of 30 or higher (Group 2). The median age was 47 (±12.6) and 52.2 (±8.4) for Groups 1 and 2, respectively. The median BMI was 26.1 (±2.3) for Group 1 and 31.8 (±1.5) for Group 2. There was no significant difference in operation time (P = .980) between the 2 groups. There was no difference in the length of hospitalization with an average hospital stay of 3 days for both groups. No major complications were observed in either group. There was no difference in minor complication rates for both groups. CONCLUSION: High BMI donors can safely donate their kidney with no significant increase in complication rates at high-volume transplantation centers.

Comparison of Preemptive Kidney Transplantation With Nonpreemptive Kidney Transplantation in a Single Center: A Follow-up Study.

BACKGROUND AND AIM: The effect of preemptive transplantation of kidneys from living donors on patient and allograft survival is controversial. In this study, we aimed to evaluate whether preemptive kidney transplantation performed without the development of patient dialysis-related complications has a favorable effect on patient and graft survival. PATIENTS AND METHOD: The study included 334 adult renal transplant recipients. Patients who underwent renal transplantation between January 2008 and December 2012 at a tertiary referral teaching hospital were followed, and outcomes were obtained by retrospective chart review. A total of 244 patients underwent dialysis before renal transplantation, whereas 90 patients underwent preemptive transplantation. RESULTS: There were no significant differences between the 2 groups with regard to patients and graft survival rates (P > .05). Patient survival rates in preemptive and nonpreemptive groups were 98.9% and 96.3% in the first year, respectively (P = .199). Graft survival rates in preemptive and nonpreemptive groups were 96.7% and 93.0% in the first year, respectively (P = .163). Patient survival rates in preemptive and nonpreemptive groups were 98.9% and 95.7% in the third year, respectively (P = .155). Graft survival rates in preemptive and nonpreemptive groups were 93.5% and 88.5% in the third year, respectively (P = .138). There was a significant difference among years with regard to ratio of patients with preemptive transplantation (P = .009). The ratio was 17.5% in 2008, whereas it rose to 43.1% in 2012. CONCLUSION: Although preemptive kidney transplantation does not provide a significant patient and allograft survival advantage compared to nonpreemptive kidney transplantation, both therapeutic modalities provide good outcomes. Preemptive kidney transplantation has been an increasingly frequent renal replacement therapy option in recent years.

Comparison of Patients in Whom Double-J Stent Had Been Placed or Not Placed After Renal Transplantation in a Single Center: A Follow-up Study.

BACKGROUND: Double-J (DJ) stents play an important role in modern urology to prevent undesirable side effects after surgery. We aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, urinary tract infection (UTI), and hematuria in the patients who underwent renal transplantation (Tx). METHODS: Data of 354 patients who underwent renal Tx between 2008 and 2011 at Ege University were evaluated retrospectively; 331 patients were included in this study. The term DJ (-) represents patients in whom a DJ stent was not placed. "Primary DJ term" represents patients in whom the DJ stent was placed during the first Tx. "Secondary DJ term" represents the patients who had DJ after Tx for any complication. RESULTS: Two hundred fifty-four (76.7%) patients were in the DJ (-) group, 52 (15.7%) were in the primary DJ group, and 25 (7.6%) were in the secondary DJ group. There were significant differences between the groups in terms of anastomosis type (P = .000), stay-in-hospital time (P = .000), surgical complication (P = .000), re-operation (P = .000), percutaneous nephrostomy (P = .000), UTI (P = .000), first-time UTI (P = .000), recurrent UTI (P = .000), positive hemoculture (P = .000), hematuria (P = .000), duration of dialysis before Tx (P = .000), live/deceased donor (P = .000), and delayed graft function (P = .009). CONCLUSIONS: Our choice is to use the DJ stent in selected high-risk patients and to keep the indications for DJ stent wider in deceased donor transplants by considering possible surgical complications. The use of the stent only in selected cases will decrease surgical complications due to stent placement.

Kidney transplant recipients with functioning grafts for more than 15 years.

BACKGROUND: Renal transplantation is the best renal replacement therapy because it significantly improves patient survival. The developments in transplantation and increasing number of patients with end-stage renal disease (ESRD) have unmasked long-term complications secondary to immunosuppressive drugs and chronic renal failure. METHODS AND RESULTS: Eighty-six renal transplant recipients with grafts that have functioned more than 15 years were included in the study. This cross-sectional retrospective analysis of demographic, clinical, and laboratory findings was conducted in 3 Turkish transplantation centers. The mean age was 30.4 ± 10.2 years at the time of the transplantation. The mean time between the transplantation and the study was 19.1 ± 3.6 years. At the time of the study, mean creatinine level was 1.52 ± 0.60 mg/dL, 70.09% of the patients displayed glomerular filtration rates <60 mL/min/1.73 m(2). Urinary protein excretion was 0.57 ± 0.65 g/d. Hypertension and hyperlipidemia were the most common comorbid diseases. Twelve patients had diabetes and 9 cardiovascular disease. Seventeen patients had been diagnosed with skin and 5 with non-skin cancer. CONCLUSIONS: As the number of recipients with long-term functioning grafts increases, long-term complications become evident, particularly chronic renal failure. Survivors should be evaluated regularly and treated early for risk factors and complications to improve long-term graft and patient survival.

Clinical everolimus experience in pediatric renal transplant patients.

OBJECTIVE: Everolimus is a potent immunosuppressive agent that has antiproliferative activities. This study sought to share our experience among renal transplanted children who required conversion from calcineurin inhibitors (CNIs) to the mammalian target of rapamycin inhibitor everolimus. PATIENTS AND METHODS: Exclusion criteria were multiple organ transplantations, loss of a previous graft due to immunologic reasons, receipt of an organ donated after cardiac death, donor age <5 years or >65 years, panel reactive antibodies >25%, platelets <75,000/mm(3), absolute neutrophil count of <1,500/mm(3), leucocytes <2,500/mm(3), hemoglobin <6 g/dL, severe liver disease, cold ischemia time >40 hours or anti-HLA panel-reactive antibodies >50%. RESULTS: Eighteen renal transplant patients (10 male, 8 female) underwent conversion to everolimus from CNI: 8 from cyclosporine (CsA) and 10 from tacrolimus. The mean age was 12.6 ± 0.9 years and the mean body mass index 21.8 ± 1.7 kg/m(2). The mean 2-hour postdose level of CsA before conversion was 671 ± 142 ng/mL; the patients on tacrolimus showed a mean trough concentration of 4.5 ng/mL. Six (33,3%) were taking mycophenolate mofetil and 12 (66.6%) enteric-coated mycophenolate sodium. No significant changes were observed in either hepatic functions, serum lipids, or hemograms. There was no mortality or graft loss. The mean level of serum creatinine was 1.3 ± 0.7 mg/dL before and 1.09 ± 0.6 mg/dL after conversion. Proteinuria observed in only 1 patient was well controlled with angiotensin-converting enzyme inhibitor therapy. All patients responded to statin therapy. One patient developed unilateral lower extremity edema and 1 a lymphocele. Although there were 3 cases (14%) of biopsy-confirmed acute rejection, there was no mortality or graft loss. CONCLUSIONS: Everolimus conversion has become an excellent choice, offering safety and efficacy with good outcomes.

Use of suicidal deaths as kidney donors: a single-center experience.

OBJECTIVE: Although the number of end-stage renal disease patients on the waiting list has increased, the number of deceased kidney donors has not increased proportionately. Therefore, the use of kidney donors defined as "marginal" has become an issue. Since the acceptance of deaths due to poisoning or suicide as donors has been proposed, we evaluated the clinical courses of kidney transplantations from suicidal death donors. PATIENTS AND METHODS: We analyzed retrospectively the outcomes of nine deceased donor kidneys (8 males) from suicide victims between 2001 and 2012. Demographic and clinical characteristics of donors and recipients were collected from medical files. RESULTS: The mean donor age was 27.8 ± 11.9 years. Causes of death were: gunshot wounds to the head (n:4), pesticide intoxication (n:2), methanol intoxication (n:1), hanging (n:1), or carotid artery laceration (n:1). Mean donor creatinine level, urine output per hour, and 24-hour urine volume were 0.94 ± 0.53 mg/dL, 270 ± 113 mL, and 5496 ± 832 mL, respectively. Mean cold ischemia time was 12.3 ± 5.7 hours. Primary allograft nonfunction occurred in one recipient requiring nephrectomy. The average posttransplantation creatinine level at 1 year was 1.19 ± 0.62 mg/dL. The mean follow-up was 55 ± 49 months. Allograft loss occurred due to chronic rejection in three patients at 10, 37, and 40 months. Five patients are still undergoing follow-up with functioning grafts. CONCLUSION: Brain death cases caused by the suicide should be considered for organ donation.

Evaluation of myocardial function using tissue Doppler imaging in children with moderate scorpion envenomation.

CONTEXT: Scorpion envenomation is an important public health problem. It can cause life-threatening complications such as respiratory, neurological and cardiovascular compromise. Systemic envenoming signs and mortality rates are dramatically higher in children. OBJECTIVE: The objective of this study was to evaluate myocardial function using pulsed tissue Doppler imaging in patients with moderate scorpion envenomation. MATERIALS AND METHODS: The study was conducted from July to October 2009 in the South-East Anatolia region of Turkey. The study population consisted of 30 children with moderate scorpion envenomation and 30 age- and sex-matched normal controls. Severe and mild envenomations were excluded. In addition to echocardiographic examination, pulsed tissue Doppler imaging was performed. RESULTS: The average age was 7.6 ± 4.3 years in patients and 7.9 ± 3.2 years in controls (p value, 0.77). The mean heart rate was 114 ± 19 beats/min (range, 72-164) in patients and 95 ± 14 beats/min (range, 72-127) in controls (p < 0.01). Sinus tachycardia (> 120 beats/min in children) was detected in ten (33.3%) patients. Myocardial performance index (MPI) was obtained with tissue Doppler imaging. The ejection fraction, the fractional shortening, the MPI of the left ventricle, the MPI of the right ventricle, the left ventricular isovolumetric contraction time (ICT), the left ventricular isovolumetric relaxation time (IRT), the left ventricular ejection time, the right ventricular ICT, the right ventricular IRT and the right ventricular ejection were not statistically different between the patients and the controls (p > 0.05). DISCUSSION: We did not detect any considerable myocardial involvement in the children presenting with moderate scorpion envenomation except for sinus tachycardia. If the patients are treated with antivenom within 4 h, patients with moderate scorpion envenomation may not develop cardiac dysfunction.

Use of kidney donors with hepatitis B, hepatitis C, or brain tumor: a single-center experience.

INTRODUCTION: With the rapid increase in the number of patients on the waiting lists, the idea of using organs from donors who were previously classified as "marginal" has emerged. The aim of this study was to evaluate the clinical outcomes of the patients who received kidneys from donors with hepatitis B, hepatitis C, or brain tumors. PATIENTS AND METHOD: Between 2003 and 2010, 27 transplantations were performed from donors with hepatitis B, hepatitis C or brain tumors between 2003 and 2010. Demographic and clinical characteristics of donors and recipients were retrospectively collected from medical files. RESULTS: Fifteen patients received kidneys from donors with hepatitis B: 9 from deceased donors having a positive hepatitis B surface antigen (HBsAg) and six from living donors with positive HBsAg having negative results of qualitative hepatitis B DNA analysis. Two of the fifteen recipients were previously diagnosed with chronic active mild hepatitis B infection. The remaining 13, who were HBsAg (-)/anti-HBs(+) at the time of transplantation, underwent hepatitis B immune globulin and lamivudine therapy. Median follow up time was 40 ± 35 months. One patient developed decompensated liver disease owing to noncompliance to lamivudine therapy. Five patients who received grafts from anti-HCV(+) deceased donors were anti-HCV(+) at the time of transplantation with alanine aminotransferase (ALT) levels <40 U/L. All grafts remained functional at a median of 70 months. Seven subjects received grafts from deceased donors with brain tumors, none of whom had a history of a craniotomy or a ventriculoperitoneal shunt. All recipients had serious vascular access problems. No graft loss or de novo malignancies was observed among these patients after a median follow-up of 69 ± 26 months. CONCLUSION: With appropriate patient selection, the donated organ pool can be expanded by addition of donors with hepatitis or brain tumors.

What kind of changes occurred in clinical characteristics of deceased kidney donor recipients after national allocation system in Turkey? A single-center retrospective analysis.

OBJECTIVE: Clinical characteristics of recipients of deceased donor renal transplantations were evaluated in the period before versus after implementation of The National Allocation System (NAS). PATIENTS AND METHODS: We evaluated retrospectively clinical profiles of the 42 after NAS (June 2008-December 2010) versus 42 consecutive deceased donor renal transplantation patients before NAS. Patient and graft survival rates were assessed using the Kaplan-Meier method; graft function was assessed based on creatinine clearance with the Cockcroft Gault equation. Patient and donor data were obtained from medical records. RESULTS: Recipients were older in the pre-NAS group (39 ± 8 vs 33 ± 8 years, respectively; P = .001) and median duration of preoperative dialysis was longer in the post-NAS group (103 ± 61 months vs 50 ± 36 months, respectively; P = .000). The average number of human leukocyte antigen-mismatched antigens were pre-NAS 3.4 ± 1.0 versus post-NAS 3.9 ± 1.2 (P = .05). Considering the recipients serological status 9 were hepatitis C virus (HCV)(+) and 2 hepatitis B virus (HBV)(+) among the post-NAS versus no HBV(+) and only 1 HCV(+) patient pre-NAS. Kaplan-Meier analysis of graft survival rates showed 90% at 1 and 85% at 3 years pre-NAS. Similar to 95% at 1 and 86% at 3 years for the post-NAS group (P > .05). Likewise, patient survival rates for both groups at 1 and 3 years were 97%. The mean parameter of donor age, allograft loss, cold ischemia time, patient death, number of retransplantations, HBV(+) patients, and delayed graft function were similar between groups (P > .05). DISCUSSION: After NAS the transplant recipients were older, had a longer duration of dialysis, greater number of HLA mismatched antigens and, more HCV(+). No differences were observed in short-term patient and graft survival rates.

Long-term outcomes of kidney transplants with multiple renal arteries: a retrospective study.

OBJECTIVE: The aim of this study was to investigate whether kidney transplantations performed using grafts with multiple arteries negatively affected renal function or increased the risk of vascular or urologic complications. METHODS: Among 249 kidney transplant patient followed for at least 1 year between 2000 and 2005, we retrospectively evaluated their donor renal artery anatomy to compare postoperative vascular and urologic complications: creatinine clearance at 1, 2, and 5 years, as well as graft survival at 3 and 5 years. RESULTS: While 214 (85.9%) displayed a single artery (group 1), 35 (14.1%) showed multiple renal arteries (group 2). Thirty-one of the group 2 allografts had two, three donors had three, and one had four arteries. The postoperative vascular and urologic complications and the creatinine clearance values at 1, 2, and 5 years of both groups were similar. The 3- and 5-year graft survivals among group 1 were 95% and 90%, whereas those of group 2 were 94% and 91% respectively (P < .05). CONCLUSION: Our study indicated that multiple renal arteries did not adversely affect postoperative urologic or vascular complications or kidney allograft or patient survival compared with single renal artery cases.

Spousal versus living unrelated renal transplantation: a retrospective analysis of allograft outcomes.

OBJECTIVE: To compare the outcomes of spousal and living unrelated donor (LUD) allografts. PATIENTS AND METHODS: The 378 ABO-compatible living and cadaveric kidney transplantations between February 2005 and August 2010 included 25 wife-to-husband (group 1), 15 husband-to-wife (group 2), and 20 LUD cases (group 3). Donor nephrectomy was performed by open surgery. Induction therapy with antithymocyte globulin or anti-interleukin-2 receptor antibody was followed by maintenance regimens using cyclosporine (CsA) or tacrolimus (Tac) plus mycophenolate mofetil (MMF) and corticosteroids. We compared spousal donor and LUDs in terms of clinical characteristics as well as graft and patient survival rates. RESULTS: Fifty-six (93.3%) patients underwent induction therapy with either antithymocyte globulin (n = 30) or anti-interleukin-2 receptor antibody (n = 26). Maintenance immunosuppression was administered with Tac + MMF (n = 37; 61.6%) or CsA + MMF (n = 23; 38.4) with corticosteroids. Mean follow-up was 34 ± 16 months. There were four graft losses and five patient deaths. There were no significant differences between spousal and living unrelated transplants in terms of clinical characteristics or biopsy-proven acute rejection episodes. The Kaplan-Meier analysis showed 3-year patient survival rates of 94%, 100%, and 88% in group 1, group 2, and group 3, respectively (P > .05). Overall graft survival rates were 94%, 100%, and 77% in group 1, group 2, and group 3, respectively (P > .05). Graft and patient survival rates were similar at 3 years for wife-to-husband, husband-to-wife, or LUDs. CONCLUSION: In conclusion, family members should be encouraged as LUD or spousal donors, based on similar patient and graft survival rates.

Chemical peritonitis associated with high dialysate acetaldehyde concentrations.

BACKGROUND: During the standard heat sterilization process of lactate-buffered peritoneal dialysis (PD) solutions, glucose degrades to form compounds called glucose degradation products such as acetaldehyde, formaldehyde, or glyoxal. Despite evidence that these products may be responsible for some in vitro cytotoxic effects induced by commercially available PD fluids, data on their acute or chronic effects on the human peritoneum is scarce. SUBJECTS AND METHODS: This case presentation is based on an observation of 21 aseptic peritonitis cases of unknown aetiology. All cases appeared within one month in a university hospital PD unit that had a peritonitis rate of 1 episode/26 patient months and 55 active patients on CAPD. Acetaldehyde level in the bags was assayed by gas chromatography. RESULTS: Twenty-one patients presented with signs of peritonitis including cloudy dialysate and abdominal tenderness with additional abdominal pain in 11 patients and vomiting in one. In all cases, cultures and Gram stains were negative for micro-organisms. Fever was not observed in any patient. Average dialysate white blood cell count was 1795/mm(3). All patients were free of intraperitoneal medication when symptoms appeared. Patients were using PD solutions from a newly established domestic production plant. Apparently all patients with symptoms of peritonitis used bags with the same lot number and the solution in the bags appeared to be darker in colour than that in bags with other lot numbers. Chemical analysis of the unused PD solution samples revealed acetaldehyde levels of 17-20 p.p. m. in bags containing darker solution, which is very high compared with the usual acetaldehyde level of 6 p.p.m. in heat-sterilized PD solutions. CONCLUSIONS: Based on the above findings, we hypothesize that higher levels of acetaldehyde and possibly other glucose degradation products may have been an aetiological factor in these 21 cases of chemical peritonitis. Our observation suggests that acetaldehyde, in concentrations 3-4 times higher than the usual level in commercially available PD solutions, may induce acute sterile peritonitis in CAPD patients.