C. Hiesse

Gastrointestinal complications in renal transplantation

Abstract. One wonders whether the use of cyclosporin, histamine receptor antagonists, low doses of steroids, and early diagnosis and treatment actually modify the incidence, morbidity, and mortality of gastrointestinal (GI) and pancreatic complications in renal transplantation. To find out, we reviewed 614 kidney transplant recipients between January 1984 and December 1988. One hundred patients (16.2 %) were found to have GI and/or pancreatic complications in the following distribution: 9.6% gastroduodenal, 1.3% pancreatic, 4% colonic, and 0.4% small bowel. None of the patients presenting a gastroduodenal ulcer had perforation or bleeding. Fifty‐five percent of the patients with this complication had a past history of eso‐gastroduodenal disease, compared to 19.6% in recipients without gastroduodenal complications. Some 4.4 % of the patients had a small bowel or a colonic complication and four died of peritonitis due to bowel perforation. Mortality was 35 % in those having intestinal resection and/or perforation with peritonitis. Sixteen percent of patients with colonic complications had a known history of diverticula, compared to 3 % for those without colonic complications. The incidence of GI and/or pancreatic complications in renal transplant recipients remains high and has caused 1.1 % of the deaths in our series. Mortality is essentially due to upper GI bleeding, peritonitis following perforation, and infectious colitis. Better detection of gastroduodenal and colonic disease before transplantation seems to be mandatory. Prevention with histamine H2 receptor antagonists and early surgical treatment of complicated colonic diverticula help to reduce the morbidity and mortality in kidney graft recipients.

Renal Transplantation and Active Lupus Erythematosus

Excerpt To the editor:In patients with end-stage renal disease due to lupus nephritis, uremia and hemodialysis result in a burnt-out, or clinically inactive state that no longer needs treatment. ...

Human Immunodeficiency Virus Infection in Transplant Recipients

Excerpt To the editor: Recent reports have focused attention on recipients of kidney allografts or transfusions from donors infected with the human immunodeficiency virus (HIV; formerly known as HT...

Multiple drug combinations with “low‐dose” cyclosporin for renal transplantation: Multivariate analysis of risk factors determining short‐term graft survival within one renal transplant center

Abstract. The factors affecting graft survival in transplant recipients receiving cyclosporin (CsA) are still being debated. Our report is based on an analysis of 202 successive transplantations performed in our institution from May 1984 to December 1986, using low‐dose CsA as the basic means of immunosuppression. A total of 142 patients received the triple combination CsA, azathioprine (AZA), and corticosteroids. Sixty patients received a prophylactic combination of CsA, corticosteroids, and antilymphocyte globulins (ALG). From January to December 1986, both regimens were compared in a prospective randomized trial. The factors that affect graft survival were analyzed using the Cox multivariate hazard analysis. The relative risks were calculated for pre‐transplant baseline risk factors and for outcome‐dependent post‐transplant risk factors for surviving grafts at 1 month. Transplants performed with a prolonged ischemia time and patients whose graft did not function immediately were statistically at higher risk of graft loss. Adding prophylactic ALG to CsA was associated with better graft survival. Patients who experienced more than 1 rejection crisis and patients whose 1‐month CsA dose was lower than or equal to 5 mg/kg per day were also at significantly higher risk of further graft loss. Neither HLA matching, peak panel reactivity, age of the recipient, occurrence of post‐transplant renal dysfunction nor 1‐month renal function affected the short‐term graft outcome.

Therapeutic intervention on preformed anti-HLA antibodies

The presence of broadly reactive antibodies directed at allogeneic lymphocytes is a major and increasing cause of delay in transplantation of patients with end-stage renal disease. In addition, hyperimmunized status is associated with a lower graft success rate that non-immunized status, unless patients were transplanted with excellent matched graft. Hyperimmunized patients represent an increasing proportion of graft waiting list, caused by previous graft failure, pregnancies and blood transfusions.