G. Dallos

Results and Complications after Living Related Kidney Transplantation in Hungary: 30 Years' Experience

The number of patients suffering from kidney disorders is increasing the need for kidney transplantation. Kidneys originating from living donors (LD) show substantially better results than those originating from cadaveric donors (CD). We performed 3000 kidney transplantations between November 1973 and December 2007, including 154 from LD (5.13%). The early kidney function as measured by the delta creatinine clearance was significantly better among the LD group (P < .001). There was no significant difference in the immunologic data between the LD and the CD groups (P = .047). Four years after transplantation the glomerular filtration rate (GFR) and the serum creatinine level treated to be better among the LD group with tacrolimus versus cyclosporine immunosuppression (P = .089). In the LD group, the acute rejection rate was lower with tacrolimus- versus cyclosporine based immunosuppression (P = .014).

Central opiate receptor blockade by naloxone impairs thalamic and hypothalamic autoregulation in the cat

Abstract Experiments were carried out in order to determine the effects of centrally induced opiate receptor blockade on the autoregulation of the regional cerebral blood flow (rCBF, measured by the H2-gas clearance technique) of the anesthetized, ventilated cats. General opiate receptor blockade was induced by intracere- broventricularly (i.c.v.) injected naloxone. Changes of the lower limit of hypothalamic, thalamic and white matter blood flow autoregulation were studied by reducing the systemic mean arterial pressure (MAP) in a stepwise manner to 80 mmHg, 60 mmHg and 40 mmHg by hemorrhage. Centrally administered naloxone (10 μg/10 μl/kg, i.c.v.) resulted in an abolishment of the autoregulatory mechanisms in the hypothalamic and thalamic regions but caused no such changes in the white matter. These observations suggest that 1.) intracerebral opiate receptors and/or central opioid peptiderg mechanisms play a significant role in the maintenance of the thalamic and hypothalamic blood flow autoregulation during hemorrhagic hypotension and 2.) the involvement of the endogenous opioid peptide system in rCBF autoregulatory mechanisms is regionally different.

Successful urinary tract reconstruction following ureteral necrosis in kidney transplant patient

Abstract Ureteric complications following renal transplantation are well known to cause significant morbidity and compromised graft survival. The necrosis of a major part of the ureter could be a highly detrimental situation, and hardly solvable complication, that poses great challenges. Herein we are presenting a case report to introduce a possible surgical solution following repeated ineffective radiological interventions, in a patient with ureteric necrosis that appeared 3 months after cadaveric kidney transplantation. We transplanted the right kidney to the right iliac fossa performing end-to-side vascular anastomoses and end-to-side uretero-ureterostomy. His clinical course was uneventful during 3 months, when he presented a mild borderline acute cellular rejection together with dilatation of the pyelon. Percutaneous nephrostomy was performed by interventional radiologist. During further radiologic interventions the stenosis was not permeable. We finally made up our minds for surgical solution. We fo...

[Can urinary neutrophil gelatinase-associated lipocalin predict acute rejection following deceased donor kidney transplantation?].

INTRODUCTION Delayed graft function and acute rejection have negative impact on graft survival. AIM To asses the predictive value of urinary neutrophil gelatinase-associated lipocalin, which has been found to be a promising biomarker for the diagnosis of acute kidney injury. METHOD In this prospective study urinary neutrophil gelatinase-associated lipocalin levels of 27 kidney recipients were measured. RESULTS Patients were grouped as follows: group 1, no complication; group 2, rejection; group 3, delayed graft function requiring dialysis; group 4, rejection plus delayed graft function. There were no significant differences between groups 1 and 2, and between groups 3 and 4. Patients in groups 3 and 4 had significantly higher urinary neutrophil gelatinase-associated lipocalin levels as compared to those in groups 3 and 4. There was a paralIel change in urinary neutrophil gelatinase-associated lipocalin levels in groups 1 and 2. CONCLUSIONS In these patients urinary neutrophil gelatinase-associated lipocalin levels failed to provide useful information in both cases of normal and impaired function.Absztrakt Bevezetes: Veseatultetes utan mind a graft kesleltetett műkodese, mind az akut rejekcio negativan befolyasolja a tulelest. Celkitűzes: A neutrofil gelatinaz asszocialta lipokalin igeretes biomarkernek tűnik az akut karosodasok diagnozisaban. Modszer: Prospektiv vizsgalatban 27 felnőtt veserecipiens vizelet neutrofil gelatinaz asszocialta lipokalin erteket mertek es megvizsgaltak prediktiv erteket. Eredmenyek: A betegeket 4 csoportba osztottak (nincs komplikacio, rejekcio, kesői indulas dializisigennyel, rejekcio + kesői indulas). Nem talaltak szignifikans kulonbseget a nincs komplikacio es rejekcio, valamint a kesői indulas dializisigennyel es rejekcio + kesői indulas csoportok kozott. A kesői indulas dializisigennyel es rejekcio + kesői indulas csoportok neutrofil gelatinaz asszocialta lipokalin szintje lenyegesen magasabb volt, mint a nincs komplikacio es rejekcio csoportoke. A nincs komplikacio es rejekcio csoportokban a kreatinin es neutrofil gelatinaz asszocialta lipokalin szintjei parhuzam...