Liver disease in renal transplant recipients.

Significant liver disease developed in 14 patients after renal transplantation. Nine patients had morphologic and functional evidence of chronic active hepatitis. In general, these patients had few symptoms of liver disease, even though the course of chronic active hepatitis was progressive. Despite large doses of prednisone, cirrhosis ultimately developed in five patients. The cause of chronic active hepatitis could not be related to azathioprine or methyldopa therapy because there was no perceptible change in the course of liver disease after treatment with these drugs was stopped. Three patients were persistently positive for hepatitis B surface antigen. Isolated instances of granulomatous hepatitis (Mycobacterium kansasii) and of prolonged intrahepatic cholestasis were encountered in patients with chronic active hepatitis. Two patients had acute cytomegalovirus hepatitis. There was one episode each of fulminant herpes simplex hepatitis and severe fatty metamorphosis.

Accelerated atherosclerosis, aneurysmal disease, and aortitis: possible pathogenetic association with cocaine abuse.

Cocaine abuse and its association with vascular disease has become common in the medical literature. A variety of vascular problems have been described including neurovascular complications, cardiovascular complications, aortic dissection, venous thrombosis, mesenteric artery thrombosis, and renal infarction. The pathogenesis of these vascular complications has largely been related to increased adrenergic activity leading to vasospasm. Interaction of cocaine with the vascular endothelium resulting in thrombosis or vasculitis has also been suggested. We report a case of diffuse aneurysmal change of the aorta associated with an atypical inflammatory component consistent with possible cocaine induced vasculitis.

Critical comparison of renal transplant survival between recipients of live related donor and cadaver organs.

Survival statistics of 163 cadaver and 60 live related donor renal transplants from a single center were analyzed. Survival rates at one, two and three years for 38 first cadaver transplants matched for a haplotype and 34 first live related donor haplotype matched kidneys were virtually the same. In addition, nine, four antigen matched cadaver transplants had a comparable survival rate at one, two and three years to the larger group of 25 HL-A identical live related donor kidneys. When poor risk cadaver recipients were excluded from the entire cadaver group, the graft survival rate approached that of the live related group at one year but declined more rapidly at two and three years than did the live related donor group. Thus, cadaver renal transplantation in this series appears to be an alternative to comparably matched live related donor transplants. An increased effort should be made to identify and use brain death cadaver donors for transplantation. As more donors become available and national sharing systems are improved, a strong case can be made to avoid the use of live related donor kidneys, except in instances of a perfect match.

Severe generalized reactions to ibuprofen: report of a case.

A 46-year-old asplenic, nonatopic woman experienced at least one severe generalized reaction to ibuprofen. During her initial hospitalization for suspected septic shock, several laboratory results suggested disseminated intravascular coagulation. Results of oral dye, preservative, and aspirin challenges and tests for systemic lupus erythematosus were negative. She had remained well since she stopped taking ibuprofen. Awareness of the possibility of severe reactions to ibuprofen should be maintained when this medication is prescribed.