Kidney donors don't regret: follow-up of 370 donors in Stockholm since 1964.

BACKGROUND: The aim of the study was to present the views of our kidney donors since 1964, at the time of donation, as well as later on--and to assess their current subjective health. METHODS: A total of 451 living-donor nephrectomies were performed on Swedish residents in Stockholm from April 1964 until the end of 1995. A questionnaire with 11 questions about the donation and a standardized health form (SF-36) were sent to all donors alive in 1997 (n=403). RESULTS: The mean age (+/-SD) of the donors was 61+/-14 years at follow-up and the time-since-donation was 12.5+/-7.7 years. The response rate was very good (92%). Current health, as assessed by form SF-36, was satisfactory. Donors scored somewhat better than those reported in a random sample of the Swedish population. The decision to donate had been easy: 86% made the decision themselves, without being pushed. Twenty-three percent thought that the nephrectomy had been troublesome. A higher percentage of young donors had felt that the postoperative period was difficult. Most donors (56%) stated that it had taken more than 2 months before they returned to a "normal" life, and 5% felt that they never completely recovered. Less than 1% of the donors regretted the donation. The commonest current medical prescription was antihypertensives (15%). The actual mean serum creatinine was 103+/-22 (range 48-219) micromol/L. CONCLUSIONS: The results indicate that the degree of health is at least as high as in the general population. The decision to donate was easy for most of the donors, but surgery and the recovery period were troublesome and lasted longer than expected. Kidney function was acceptable.

Presence of anti-hepatitis C virus serum markers in a dental school patient population.

Hepatitis C virus (HCV) has joined the list of infections liver diseases of which the practicing dentist must be aware. This recently described RNA virus causes between 20% to 40% of reported cases of viral hepatitis in the United States. Patients with HCV show symptoms only one quarter of the time, but chronicity is maintained longer than with the other liver infections. The major mode of transmission is percutaneous, so dentists are potentially at risk to contact the virus. To assess the presence of exposure to HCV, a total of 500 dental school patients were screened for serum antibody to this virus (second-generation anti-HCV). In addition, participants were required to fill out a special screening questionnaire designed to indicate high-risk groups. Their serum was also analyzed for serum chemistries known to be associated with acute and chronic liver disease. Analysis of the 15 response questionnaires revealed statistical significance relating to questions inquiring about previous exposure to blood (transfusions, surgical procedures, etc) but little significance relating to lifestyle. In either case responses were not of practical predictive value. More than 5% of our sample patients were found to be positive reactors to anti-HCV, indicating previous HCV exposure. A significant number of those positive for anti-HCV also showed elevation of serum chemistries associated with hepatitis.

HIV-1 antibody positive hepatitis B surface antigen serum in a dental school patient population.

Testing for human immunodeficiency virus antibody (anti-HIV-1) in patients positive for hepatitis B surface antigen has never been performed in a dental school patient population. In this population there was a 2.8% positive reactivity for HIV-1 antibodies in subjects who were also positive for hepatitis B surface antigen. An enzyme-linked immunoassay with a repeat test and confirmation with a Western blot technique were used.

Public knowledge about AIDS: a survey of dental school patients. Part I.

Surveys have demonstrated that the general public has many misconceptions about acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection. Education has been the mainstay of the public health effort to combat the spread of HIV and AIDS. Some studies have shown an increase in the public's understanding of this disease. A survey of dental patients at a dental school clinic revealed that although misconceptions continue to exist, particularly with regard to AIDS and the dentist, this population had higher levels of knowledge about AIDS than did those in earlier studies.

Public knowledge about AIDS: a survey of dental school patients. Part II.

Responses to a questionnaire on acquired immunodeficiency syndrome (AIDS) returned by patients of the Louisiana State University School of Dentistry were compared with responses to an AIDS questionnaire administered by the National Center for Health Statistics (NCHS). Although the questionnaire in this study was not patterned after that used by NCHS, some of the questions were either similar or directly opposite in content. Response patterns were compared and contrasted. In addition, those response patterns in Part I which are significantly different on the basis of demographic characteristics were compared with their counterparts in the NCHS survey.

Subclass reactivity to Epstein-Barr virus capsid antigen in primary and reactivated EBV infections.

A new method for analysis of virus-specific Immunoglobulin G (IgG) subclasses was developed using indirect immunofluorescence. Three hundred thirty-three serum samples from patients with different types of Epstein-Barr virus (EBV)-associated diseases and healthy controls were examined for subclass distribution to the virus capsid antigen (EBV VCA). EBV-VCA-expressing cell preparations were incubated with patient serum followed by monoclonal antibodies to human IgG1 through IgG4 and labelled anti-mouse IgG. Virus-specific IgG1 was found to be the dominant antibody. The titers for IgG1 and total Ig to EBV VCA correlated well. EBV VCA-specific IgG2 was not found. EBV VCA-specific IgG3 in a titer of greater than or equal to 10 was found in 33% of healthy seropositive donors, in 97% of patients with suspected reactivated EBV infection, and in 100% of symptomatic patients with suspected reactivated EBV infection. EBV VCA specific IgG3 occurred in 90% of placebo-treated compared to 30% in long-term acyclovir-treated bone marrow transplant recipients, indicating more frequent reactivations in the former group. IgG4 to VCA was infrequently found in seropositive persons. In serum samples from patients with nasopharyngeal carcinoma and high EBV VCA Ig and IgA titers, IgG4 to VCA was always present. Analysis of EBV VCA specific IgG subclasses seems to be valuable for the diagnosis of reactivated EBV infection.

Long-term acyclovir prophylaxis in bone marrow transplant recipients and lymphocyte proliferation responses to herpes virus antigens in vitro.

In this randomized double-blind and placebo controlled trial of 6 months' prophylaxis with acyclovir (ACV) in 42 bone marrow transplant (BMT) recipients, patients receiving ACV had fewer herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections during the prophylaxis compared to the placebo treated patients (P less than 0.05). During the first 6 months after the prophylaxis had been discontinued the frequency of clinical HSV reactivations was low both in the ACV (1/13) and in the placebo (1/13) treated patient groups. Altogether the ACV treated patients had significantly fewer HSV reactivations during the first year after BMT (P less than 0.05). The HSV-specific lymphocyte proliferation response was also lower in the ACV treated group at 3, 6 and 12 months after BMT (P less than 0.05). VZV infections recurred rather frequently, however, after discontinuation of ACV prophylaxis. Therefore no difference was found in the number of VZV infections during the first year after BMT. The VZV-specific lymphocyte proliferation response was significantly lower in the ACV treated group only at 6 months (P less than 0.05). ACV prophylaxis had no effect on the frequency of CMV infections; CMV-specific lymphocyte proliferative responses were not decreased.

HLA-matching and pretransplant blood transfusions in cadaveric renal transplantation--a changing picture with cyclosporin.

613 patients were included in a study to assess the extent to which HLA-matching and pretransplant blood transfusions affect the outcome of cadaveric renal transplantation in patients treated with cyclosporin and low doses of prednisolone. Matching for the HLA-DR-antigens significantly reduced the frequency of rejection episodes, but neither HLA-matching nor pretransplant blood transfusions influenced the patient and graft survival rates.

Prevention of kidney graft diabetic nephropathy by pancreas transplantation in man.

Kidney graft biopsies were performed 2-3 yr after transplantation in eight type I (insulin-dependent) diabetic patients who had previously been subjected to kidney transplantation (six patients) or combined kidney and segmental pancreas transplantation (two patients). In five of the six patients that had undergone only kidney transplantation, light microscopic examination of the graft biopsy revealed changes compatible with diabetic nephropathy, and electron microscopic morphometry showed a thickening of the glomerular basement membrane (GBM). In the two patients who had been subjected to combined pancreas and kidney transplantation, the kidney graft biopsy showed no light microscopic changes suggestive of diabetic nephropathy, and electron microscopy showed no thickening of the GBM. Thus, it appears to be possible to prevent the recurrence of diabetic nephropathy in human kidney allografts by simultaneous pancreas transplantation.

Intravenous foscarnet for the treatment of severe cytomegalovirus infection in allograft recipients.

Foscarnet, trisodium phosphonoformate, was administered intravenously to 6 immunosuppressed patients with life-threatening cytomegalovirus infection. Three of the patients were recipients of a kidney and 3 of a bone-marrow transplant. Favourable clinical responses were seen in 5 of the patients, 2 of whom were still in good health 5 and 8 months after the infection had cleared up. No toxic effect of the drug was detected. The results seem to justify further trials, in which foscarnet should be introduced at an earlier stage of the disease.

Acyclovir prophylaxis in bone marrow transplant recipients.

Forty-two patients undergoing bone marrow transplantation were included in a randomised, double-blind and placebo controlled trial of prolonged acyclovir prophylaxis against infections with viruses of the herpes group. Twenty patients were allocated to receive acyclovir and 22 to receive placebo. Acyclovir or placebo was administered i.v. at a dose of 250 mg/m2 twice daily, starting 5 days before transplantation. At 5 weeks after transplantation, administration was changed to tablets, 400 mg three times daily (children less than 6 years, 200 mg three times daily) and continued until 6 months after transplantation. In the placebo group, 10 acute herpes simplex virus (HSV) infections occurred in 7 patients (5 HSV-1 and 2 HSV-2), and another patient repeatedly shed HSV in throat washings. Five patients developed herpes zoster. Among patients receiving acyclovir only one episode of HSV infection occurred and no herpes zoster. The difference in the number of infection episodes and the number of infected patients was strongly significant (p = 0.0002 and 0.0017, respectively). The only acyclovir patient who reactivated HSV was terminally ill, and it is highly likely that she did not absorb a sufficient amount of the orally administered drug to control infection. All HSV and varicella zoster virus (VZV) infections were reactivations, and 9 of 10 patients who developed HSV infections or shed virus had a pre-transplantation HSV IgG titer of greater than 10 000 (ELISA). Acyclovir had no effect on cytomegalovirus (CMV), time of engraftment, or graft versus host disease (GVHD). Apart from a possible allergic reaction (skin rash) to acyclovir tablets, no adverse reactions were seen during this long prophylaxis with acyclovir.

Cytomegalovirus infection associated with and preceding chronic graft-versus-host disease.

Of 68 consecutive allogeneic bone marrow transplant patients, 53 survived more than three months after transplantation. Twenty-two (42%) developed chronic graft-versus-host disease (GVHD). Chronic GVHD was more common among patients who had previously experienced cytomegalovirus (CMV) infection (20/36, 56%) than among those without signs of active CMV infection (2/17, 12%) (P less than 0.01). The CMV infections preceded the development of chronic GVHD by a median of 128 days (range 23-322 days). Children below 14 years of age who had had CMV infection developed chronic GVHD as often as older patients (8/14 vs. 12/22). CMV infection may pave the way for chronic GVHD.

Human renal allograft blood flow, oxygen extraction, and prostaglandin release: their bearing on graft function.

The intraoperative blood flow, oxygen extraction, and prostaglandin production were studied in 26 transplanted kidneys. Eleven were from related donors and 15 from cadavers. Postoperative dialysis was required by four of the five recipients of a cadaveric kidney having an intraoperative blood flow of less than 200 ml/min/100 gm of tissue. All the cadaveric kidneys with a blood flow greater than this produced urine immediately after revascularization. The blood flow in the cadaveric kidneys was related to the total ischemia time, with a lower rate in kidneys preserved for more than 24 hours. There was no difference in the oxygen extraction values for the kidneys in the related donors, in their associated recipients, and in the cadaveric organ recipients. During postoperative catheterization of the renal vein the oxygen extraction for the kidneys from related donors was practically normalized, while for the cadaveric kidneys it was increased though still subnormal. This difference was also reflected in the renal function at that time. No evidence was found that prostaglandins are involved in the regulation of the blood flow to the graft kidney.