ABSTRACT
We studied the effect of initial graft function and acute rejection on graft survival in 1047 cadaveric renal transplantations during 1991-1997 with a constant policy of donor selection, graft allocation, and immunosuppression. The overall 1- and 5-year patient survival rates were 96 % and 88 %, and the 1- and 5-year graft survival (GS) rates were 92 % and 78 %. Delayed graft function (DGF) occurred in 31 % and there were 1.2 % never-functioning grafts. One-year GS in transplantations with early graft function (EGF) was 95 % compared to 87 % in DGF (P < 0.001). Donor age and cause of death, type of graft perfusion and cold ischemia time, and type and length of dialysis treatment were significant factors in determining the onset of graft function. These factors did not have a significant direct effect on GS. Early ( < 100 days) acute rejection occurred in 25 %. In transplantations without rejection, the 1 and 5-year GS was 93.3 % and 80.8 %. In acute rejection responding to steroids, the GS was equal to that up to 3 years, but after that a significantly worse survival rate was observed (1- and 5-year GS: 93.6 % and 73.4 %). DGF was detrimental to GS both in transplantations without rejection and in all rejection types.
Subject(s)
Graft Rejection , Graft Survival , Kidney Transplantation , Tissue Donors , Adolescent , Adult , Aged , Cadaver , Child , Child, Preschool , Female , Humans , Infant , Kidney/physiopathology , Male , Middle Aged , Transplantation, HomologousABSTRACT
A follow-up study of 98 patients suffering from Crohn's disease was performed to evaluate the recurrence rate of the disease and the patients' ability to cope socially with this chronic disease. Eight patients were decreased and one had emigrated, thus 89 of the patients were contacted. Two of the patients had died of Crohn's disease and another two had died of adenocarcinoma of the large bowel involved in Crohn's disease. 83% of the patients had been operated on. The cumulative rate for recurrences resulting in reoperation using the life table method was 34% at 10 years and 55% at 20 years. Even after an enterostomy, the patients who had only large bowel involvement had the best quality of life and were most able to work. On the other hand, due to the higher recurrence rate, operated patients with both small and large bowel involvement found it most difficult to cope with the disease.
Subject(s)
Crohn Disease/surgery , Postoperative Complications/surgery , Activities of Daily Living/psychology , Adaptation, Psychological , Adult , Colectomy , Colostomy , Crohn Disease/mortality , Crohn Disease/psychology , Female , Humans , Ileostomy , Life Tables , Male , Postoperative Complications/mortality , Postoperative Complications/psychology , Quality of Life , Recurrence , Reoperation , Retrospective Studies , Sick Role , Survival Rate , Work Capacity EvaluationABSTRACT
Seventeen selected patients (mean age, 74 years)--14 with rectal prolapse and 3 with persisting anal incontinence after previous operations--underwent high anal encirclement with polypropylene mesh. There was no operative mortality. Prolapse recurred in 2 (15 percent) of the 13 patients followed up for 6 months or more (mean, 3.5 years). Three (27 percent) of the 11 patients with associated anal incontinence improved functionally, as did the three operated on for persisting incontinence, but only one patient regained normal continence. No breakage, cutting out, or infection related to the mesh was observed. Because of the risk of fecal impaction encountered in three of our patients, the procedure is not advocated for severely constipated patients. Despite the somewhat disappointing results regarding restoration of continence, we find this method useful in patients with rectal prolapse who are unfit for more extensive surgery, in controlling the prolapse to an acceptable degree.