Transfused cadaver kidney donors and graft survival.

A retrospective study of blood transfusion to the cadaveric kidney donor and graft survival in 129 primary transplantations between 1973 and 1981 in a single center is presented. Only transfusions given while the donor had the fatal disease were considered. Among 109 earlier transfused recipients graft survival calculated according to actuarial methods was significantly higher in 55 patients who received kidneys from transfused donors than in 54 patients who received kidneys from donors who had not been transfused (P less than 0.05). We conclude that transfusion to the cadaveric kidney donor positively affected graft survival in recipients who had been transfused.

del(3p)(p13p21) in renal cell adenoma and del(4p)(p14) in bilateral renal cell carcinoma in two unrelated patients with von Hippel-Lindau disease.

Karyotype analyses of renal cell adenoma in one patient and bilateral renal cell carcinomas (RCC) in another unrelated patient have been performed. Both patients belonged to families with von Hippel-Lindau disease (vHL). In the adenoma, we found a clonal del(3)(p13p21) and a small clone of two cells with an additional del(14)(q13). This result indicates that the same region that is often deleted in RCC may also be deleted in a renal cortical adenoma. This finding may facilitate the localization of a tentative renal cell adenoma/carcinoma tumor suppressor locus. In the tumors from the patient with bilateral carcinomas we found a clonal del(4)(p14) on one side and on the other a del(4)(p14) together with del(14)(q13). In this case, there was no detectable 3p defect in the tumors. This result raises the question whether an alternative/additional locus on chromosome 4p may be involved in the RCC/vHL syndrome. Constitutional karyotypes were in both cases normal.

Factors reducing mortality in typhoid ileal perforation.

A retrospective study of 42 patients treated surgically for typhoid ileal perforation found the mortality to be 24%. The study suggested that general peritonitis was the main cause of death in typhoid ileal perforation. However, the high mortality was significantly improved by adequate preoperative rehydration. The combination of chloramphenicol/gentamicin/metronidazole was superior to other antibiotic regimes. No mortality was recorded with this triple drug therapy.

Severe kidney graft rejection in combined kidney and pancreas transplantation.

With a low dose, triple drug protocol for immunosuppression, more frequent and severe rejection episodes, and lower, kidney graft survival appeared after combined kidney and pancreas transplantation than after kidney transplantation alone. With increased immunosuppression using the quadruple drug protocol that includes prophylactic ATG treatment, the results after combined transplantations improved.

The social rehabilitation and quality of life in patients living with kidney transplants for more than 10 years.

Forty-six patients lived with kidney grafts for more than 10 years. The kidney function was excellent or good in 35 patients. Thirty-seven patients were in excellent physical and mental condition and were considered fully restored. Nine patients had disabling diseases of varying severity. Thirty-eight patients were employed and several had all their occupational education after transplantation. Nine of the 31 patients of fertile age at transplantation had born or fathered 15 normal children. Forty-six patients who lived with kidney grafts for more than 10 years were very well socially rehabilitated and had reached a quality of life quite comparable to that of people of the same age.

Blood transfusion in cadaveric renal transplantation-a prospective study.

177 consecutive primary cadaveric renal transplantations were performed during April 1977-October 1980 in our centre. The graft survival in 58 recipients who were transfused with two units of blood for "immunological" reasons was the same as for 107 patients transfused with 1-96 units for medical reasons prior to transplantations. Twelve non-transfused patients had a significantly lower graft survival than the transfused ones (p less than 0.01). No additional beneficial effect of transfusions exceeding two in number was found. When three or more units of blood were given peroperatively to earlier transfused recipients, a lower early graft loss due to rejection was demonstrated than when two or less units were administered. The risk of sensitization of the recipient after two units of leucocyte poor blood was low.

Planned third-party transfusions prior to first transplantations from liver related donors.

Seventy-nine first living related donor transplants performed in Gothenburg, Sweden, from April 1977 to October 1980 were studied. The patient survival was 97% at 30 months. The graft survival in HLA-identical sibling combination was 100%. Thirty previously non-transfused recipients of one-haplotype mismatched grafts were given 2 units of third-party blood as preparation for transplantation. The graft survival was 92% at 30 months. No patients became sensitized against their donor. Thirty-one recipients of haplotype-mismatched grafts, previously transfused for medical reasons, had a graft survival of 82% at 30 months. The deliberate third-party blood transfusion protocol has been rewarding and resulted in a highly satisfactory graft survival.

Pretreatment with blood transfusions in primary kidney transplantation.

Since 1977 a deliberate pretransplant transfusion protocol consisting of two units of leucocyte poor blood given minimum 6 weeks prior to transplantation was applied to earlier not transfused recipients of primary renal transplants in Gothenburg. Graft loss due to rejection at 6 months was 17% and 8% in cadaver and one shared HLA-haplotype living donor recipients, respectively. These results were very much superior to those earlier obtained in not transfused recipients in this centre. The risk of presensitization seemed low.

Blood transfusion and primary graft survival in male recipients.

The outcome of primary kidney transplantation in 241 male patients was studied with reference to pretransplant blood transfusions. 55 patients received kidneys from living related donors with one shared HLA-haplotype, 186 patients received kidneys from cadaveric donors. The graft survival was calculated after exclusion of graft loss due to non-immunological reasons. The graft survival was found to be significantly higher in transfused recipients, especially in patients receiving kidneys from living related donors.

Clinical experience of blood transfusion in renal transplantation.

A positive effect on survival of renal grafts of pretransplant blood transfusions have been reported from several centers. The aim of this study was to study if the described graft-protecting effect of blood transfusion was present in the Gothenburg material of transplanted patients, and if this effect could be achieved by deliberately transfusing previously non-transfused patients with two units of leukocyte-reduced blood. The effect on graft survival (GS) of the number and timing of transfusions to recipients, transfusions to the cadaveric donors, HLA-A, B matching, lymphocytotoxic antibodies and pretransplant hemodialysis was also studied. The study includes 844 recipients of primary renal grafts from living related and cadaveric donors (LRD, CD) and 70 patients waiting for transplantation. In the retrospective part of the study the GS of previously transfused and non-transfused non-transfused patients was compared. In the prospective part of the study a protocol with two deliberate transfusions (DT) to previously non-transfused patients was introduced. The GS of the DT group was compared to that for patients transfused for strictly medical reasons (MT) and non-transfused patients (NT). Survival of patients and grafts was calculated according to the life table method. In the retrospective part of study one year GS in LRD transplantation was 86.6% for transfused and 38.4% for non-transfused patients (P less than 0.01). In the first period one year GS in CD transplantation was 62.1% for transfused and 35.1% for non-transfused patients (P less than 0.01). The corresponding figures in the second period were 68.1% and 39.5%, respectively (P less than 0.001). In transfused recipients receiving kidneys from transfused and non-transfused cadaveric donors, the GS was 76.3% and 55.4%, respectively (P less than 0.05). In the prospective part of study the one year GS after LRD transplantation was 85.0% in both the DT and MT groups. In CD transplantation the one year GS was 73.4% and 75.7% of the DT and MT groups, respectively. The GS of each of these two groups was significantly better than that of 20.8% for the NT group (P less than 0.01). Lymphocytotoxic antibodies were detected in 5.0% of the DT group and 23.0% of the MT group (P less than 0.001). Foreign HLA-B series antigens had a negative influence on GS in the first period of the retrospective CD study. Later, no influence on GS was noted of HLA-A, B matching. Hemodialysis prior to transplantation did not influence GS.(ABSTRACT TRUNCATED AT 400 WORDS)