Kidney retrieval from cadaver donors with disseminated intravascular coagulopathy.

Cadaver kidneys from donors with DIC appear to have an increased incidence of delayed function and primary nonfunction. These kidneys may be safely transplanted if cortical necrosis is ruled out. Heparin, antiplatelet therapy, and withholding of cyclosporin A therapy in the early post-transplantation period may improve renal function if there is evidence of glomerular capillary thrombosis.

Effects of sphincterectomy on bile acid enterohepatic circulation in dogs.

Relative rates of bile enterohepatic circulation (EHC) and bile acid pool distribution were compared in intact and sphincterectomized dogs with portacaval shunt. There was no significant difference in the rates of EHC or in the bile acid pool distribution in the groups of animals. Feeding and cholecystokinin administration caused similar increases in bile acid EHC rates in sphincterectomized and intact animals. It was concluded that the sphincter of Oddi has little or no effect on these aspects of bile acid metabolism in dogs.

Portacaval shunt and measurement of canine bile acid enterohepatic circulation: effects of cholecystectomy.

Studies were made of the usefulness of serial serum bile acid determinations in dogs with end-to-side portacaval shunt for determining relative rates of bile acid enterohepatic circulation (EHC). Studies in intact and cholecystectomized dogs with shunt showed that bile acid EHC in fasting cholecystectomized animals was about three times faster than in intacts. As expected, feeding greatly increased EHC in intacts, but caused smaller but definite increases in cholecystectomized animals. Cholecystokinin (Kinevac) administration caused transient increases in intact dog bile acid EHC, but had no effect in cholecystectomized animals. These results confirm most previous studies and demonstrate that the method is sensitive and useful for comparing rates of bile acid enterohepatic circulation under different circumstances.

Canine bile acid enterohepatic circulation.

The enterohepatic circulation (EHC) of bile acids has been studied in fasting dogs with portacaval shunt maintained in the steady state. In such animals the rate of EHC is proportional to systemic blood bile acid concentration. Bile acid EHC was irregular (20 to 100% variation) when measured at 15 minute or hourly intervals. Studies showed that the variations persisted in cholecystectomized and sphincterectomized animals. The irregularities were enhanced by bethanechol chloride which increases intestinal peristalsis and suppressed by diphenoxylate HCl which slows peristalsis. The variations appear to arise from irregular patterns of intestinal peristalsis. This phenomenon may explain some variations in blood bile acid concentration observed in patients with liver disease.

Perirenal fluid collection after renal transplant.

During the two year from January 1977 to December 1978, 59 renal allograft transplant patients were studied for perirenal collections. During the second or third postoperative day and then at weekly intervals during the initial postoperative period, serial echograms were obtained. Twenty-five perirenal fluid collections were identified in 24 patients. Twelve lymphoceles, three hematomas, three urinomas, one abscess, and six undetermined collections were found. Small and asymptomatic collections were observed. Twelve lymphoceles were managed by aspiration under ultrasound guidance in five patients, closed external drainage in six patients, and nephrectomy for acute rejection 1 patient. Three patients with hematomas had evacuation and drainage with no recurrence. Among three patients with urinomas, two had Foley catheter drainage and one had uretero-ureterostomy. The patient with an abscess required a nephrectomy. Six small collections were managed consecutively, with spontaneous resolution in four patients. Large or symptomatic collections are managed accordingly. Aspiration or closed external drainage was adequate in most cases of lymphoceles. Exploration, with evacuation and drainage of hematomas, has good results. Minor urine leaks were treated with indwelling Foley catheters; major leaks necessitated surgical repair. An abscess would require drainage or nephrectomy. Small or asymptomatic collections should be treated conservatively. We have also found the routine use of ultrasound scanning postoperatively in renal transplant patients to be of value in early diagnosis and follow-up or perirenal fluid collections.

Are there any important predicting factors of renal function during hypothermic pulsatile perfusion for transplantation?

Fifty perfused cadaver kidneys transplanted in this institution were statistically analyzed with an IBM computer to determine the most important prognostic factors in long-term actual function, namely, the kidney donor warm ischemia, length of preservation, the perfusion characteristics (flow, pressure, perfusate gases, and occasionally electrolytes and osmolarity), and the recipient's response and clinical history (age, sex, race, original renal disease, HLA-antigen matching, number of transplants, number of rejection episodes, kidney function, final outcome, etc.). Although we found no significant (P greater than 0.05) correlation between graft survival and the parameters studied, high perfusate flow appeared to have an important beneficial effect on long-term graft function. Other prognostic indicators of posttransplantation renal function were not clearly seen in our study. It is important to mention that although no significant (P greater than 0.05) differences were seen, patients without diabetes mellitus, first cadaver kidney transplants, and more than two HLA-antigen matches did better than the group without these characteristics.

Role of posttransplant kidney biopsy after hypothermic pulsatile perfusion.

Biopsies were obtained from 24 perfused cadaver kidneys. The histologic findings were correlated with short- and long-term kidney function after transplantation. There was no correlation between structural findings present immediately after perfusion and transplantation and short- or long-term kidney function. Thus, we believe that one-hour posttransplant kidney biopsy does not have a role in assessing recently perfused and transplanted kidneys.