Doherty Cc

Advantages of low dose steroid from the day after renal transplantation.

We have used a low dose of steroid (20 mg of prednisolone), commencing the day after transplantation, for 151 consecutive renal transplants in 141 patients. Five patients received grafts from living related donors, 146 received cadaver grafts. All patients received azathioprine for routine immunosuppression and the first 47 received a single dose of actinomycin C i.v. for treatment of rejection. No other immunosuppressive drugs were used. This treatment provided satisfactory immunosuppression as 109 of 151 grafts continue to function for periods of 3 months to 10 years and, of 42 grafts lost, only 17 failed from rejection. The cumulative survival of first cadaver grafts at 1 and 2 years in recipients of all ages (7 to 55 years) was 77.9 and 76.0%, respectively; in recipients 15 to 34 years old, 90.9 and 86.1%, respectively. Twenty-three patients died, no patient died from infection during the admission for transplantation, and infection played a part in the deaths of only four patients. The incidence of other complications was low; seven patients developed gastrointestinal complications, one died, four patients developed diabetes, all survived; only one patient developed avascular necrosis of bone.

Cimetidine for duodenal ulceration in patients undergoing haemodialysis.

Peptic ulcer is a common problem in advanced renal failure, but most drugs for ulcers are hazardous in this condition. In a small open study cimetidine was given to nine patients with acid hypersecretion and endoscopically diagnosed duodenal ulceration who were undergoing haemodialysis. The patients obtained good pain relief and suffered no serious side effects. Both basal and stimulated acid output fell considerably and the plasma gastrin response to food increased during treatment. Two patients with recurrent vomiting during haemodialysis had a striking response to cimetidine, which suggested that such vomiting may be acid-mediated in some patients. These preliminary results suggest that cimetidine may prove to be an advance in the management of peptic ulcer in uraemic patients.

The influence of HLA-A, B, and DR matching on graft survival in primary cadaveric renal transplantation in Belfast

HLA-DR matching has been shown in a retrospective study of 72 renal transplant patients to significantly enhance graft survival at 12 months. HLA-A and -B antigen matching also increased the graft survival rate significantly. Analysis of combined HLA-A, -B and -DR matching suggested an improvement in graft survival rate with better matching, but this did not attain statistical significance. It is now our policy to use HLA-DR matching prospectively and to ensure that all recipients receive a kidney with a maximum of 1 HLA-DR incompatibility and a minimum of 2 HLA-A and -B antigens shared.

Isotope renography and long term follow-up of renal transplant patients

Isotope renography was carried out in 64 kidney transplant patients attending a follow-up clinic. Graft survival in these patients ranged from two months to ten years. Forty-one patients had normal renograms and 98% of these had satisfactory function (creatinine clearance greater than 50 ml/min). Eighteen patients showed a major renogram abnormality and 50% of these had impaired function. Five of these 18 have been explored and found to have graft complications (obstructive disease in four, chronic pyelonephritis in one). Exploration has not been undertaken in the remaining 13 but nine show evidence suggestive of graft pathology (proteinuria, impaired creatinine clearance, elevated urinary enzymes, calyceal distortion on IVP). A successful kidney transplant should result in a normal isotope renogram, and a major abnormality of the renogram suggests the presence of a graft complication, even when the creatinine clearance is unimpaired. We feel renography is useful for identification of renal transplant patients who require further investigation or closer follow-up.

Peptic ulceration, gastric secretion, and renal transplantation.

In your reference to spectacles what you say certainly applies to lenticulus spectacles with their very narrow field of vision and the 30° ring of blindness inside the spectacle frame. No wonder the patient will not accept this! I would not and finally was able to get fullsized, minimum thickness, bifocal spectacles which are no heavier than the ordinary spectacles now fashionable. As the peripheral ring scotoma is outside the spectacle frame my field of vision is adequate to drive in London every day, which I could not do wearing my lenticulus spectacles. J B MORWOOD