Brynger H

Induction of Long-Term Heart Allograft Survival in the Rat by Rabbit ATG

A rat model for induction of transplantation tolerance, by antithymocyte globulin (ATG) as sole immunosuppressive agent, was studied. Vascularized heart allografts were employed. The conditions for establishment of long-term surviving (LTS) grafts were investigated as well as some of the characteristics of the tolerant state. The tolerance-inducing effect of ATG was found to be reproducible and dose-dependent. Treatment before grafting was essential. Preimmunization of the recipient inhibited the tolerance induction, while thymectomy seemed to have the opposite effect. The differences in survival of second allografts, third party or syngeneic to the first, indicated a largely strain-specific tolerance that most probably was the result of a changed host reactivity and for its induction strictly depended on presence of the graft. There were microscopical signs of rejection in the LTS grafts, while almost no such changes could be found in second allografts from the same donor strain, transplanted to the LTS-bearing recipients.

Extracorporeal Surgery and Autotransplantation for Carcinoma of the Pelvis and Ureter

Multiple transitional cell tumours of the renal pelvis and proximal ureter of a solitary kidney were successfully managed by total ureterectomy, extracorporeal subtotal resection of the renal pelvis, autotransplantation, and calicovesicostomy. The method permits resection of a maximum of the uroepithelium of the upper urinary tract at the same time as it preserves available renal parenchyma. It also implies a new and exciting approach to the renal pelvis for endoscopic postoperative control and local treatment of the malignancy.

Suppressor Cells in Antithymocyte Globulin-Induced Transplantation Tolerance in the Adult Rat

A rat heart allograft model, for induction of transplantation tolerance by a single dose of antithymocyte globulin, was studied. Experiments were made to transfer the tolerance to syngeneic recipients, either by spleen cells or sera obtained from tolerant rats. Different doses of tolerant spleen cells caused long-term surviving (LTS) allografts when transferred to sublethally irradiated recipients. Spleen cell transfer to untreated recipients resulted in prolonged allograft survival but no LTS grafts. The results indicate the presence of a cell-mediated suppressor mechanism in the tolerant animals.

Renal graft rejection and blood transfusion before and during the transplant operation.

The outcome of 390 consecutive primary cadaveric renal transplantations in a single centre was studied with regard to blood transfusions before and during the transplant operation. The graft loss due to rejection was 38% at 12 months in the transfused group compared to 67% in the non-transfused group (p less than 0.0005). When peroperative transfusions were added to patients in the previously transfused group, the graft loss was reduced to 34% compared to 50% if no peroperative blood was given (p less than 0.05).

CAPTOPRIL IN HYPERTENSION AFTER RENAL TRANSPLANTATION

: The experience with captopril is limited in patients who are hypertensive after renal transplantation. An increased risk of side effects has been expected because of immunosuppressive therapy and a reduced renal function. We have used captopril in 58 transplanted patients with hypertension. On previous antihypertensive treatment diastolic blood pressure could not be maintained below 100 mm Hg. All patients were on immunosuppressive therapy using prednisolone in combination with azathioprine or cyclosporin. Before captopril treatment the mean s-creatinine concentration was 225 +/- 143 mumol/l. Fifty-four patients were treated for more than four weeks and 28 of them for six months or more. The mean daily dose of captopril was 90 mg. All patients also used furosemide and 2/3 were on a beta-blocker. Captopril was discontinued in nine cases within the first two months, in three because of an unsatisfactory effect on BP, in four because of side effects and in two after successful treatment of a renal artery stenosis of the transplant. The patients who were treated with captopril within the first year after transplantation responded better than patients where treatment was started more than one year after transplantation (p less than 0.05). Half of the patients given captopril early even showed a decrease of s-creatinine during treatment. Captopril in combination with a diuretic and a beta-blocker reduces blood pressure in patients with treatment resistant hypertension following renal transplantation. The risk for serious side effects is small provided that the captopril dose is low and white cell counts and s-creatinine levels are closely monitored.

A new technique of orthotopic en bloc transplantation of the porcine liver and duct-ligated pancreas

Abstract A new technique of transplanting porcine liver and pancreas en bloc in an orthotopic position is described. The pancreatic duct was ligated. Recipients were made diabetic either by total pancreatectomy or by intravenous administration of streptozotocin, (100 mg/kg body wt). Careful correction of electrolyte and fluid disturbances in recipient animals was mandatory before and after surgery. No rejection of either liver or pancreas grafts was seen. The endocrine function of the pancreatic grafts was adequate.

Captopril in Hpertension After Renal Transplantation.

The experience with captopril is limited in patients who are hypertensive after renal transplantation. An increased risk of side effects has been expected because of immunosuppressive therapy and a reduced renal function. We have used captopril in 58 transplanted patients with hypertension. On previous antihypertensive treatment diastolic blood pressure could not be maintained below 100 mm Hg. All patients were on immunosuppressive therapy using prednisolone in combination with azathioprine or cyclosporin. Before captopril went mean s-creatinine concentration was 225 ± 143 μmol/l. Fifty-four patients were treated for more than four weeks and 28 of them for six months or more. The mean daily dose captopril was 90 mg. All patients also used furosemide and 2/3 were on a beta-blocker. Captopril was discontinued in nine cases within the first two months, in three because of an unsatisfactory effect on BP, in four because of side effects and in two after successful treatment of a renal artery stenosis of the transplant. The Patients who were treated with captopril within the first year after transplantation responded better than patients where treatment was started more than one year after transplantation (p < 0.05). Half of the patients given captopril early even showed a decrease of s-creatinine during treatment. Captopril in combination with a diuretic and a beta-blocker, reduces blood pressure in patients with treatment resistant hypertension following renal transplantation. The risk for serious side effects is small provided that the captopril dose is and white cell counts and s-creatinine levels are closely monitored.