J A Lowell

Serological evidence of past hepatitis B infection in liver donor and hepatitis B infection in liver allograft

The presence of hepatitis B surface and core antibodies (anti-HBs and anti-HBc) in a liver donor without hepatitis B surface antigen is taken to indicate resolution of hepatitis B and is not considered to contraindicate donation. We report a liver transplant recipient who developed hepatitis B after such a donation. It seems that hepatitis B virus can reside in the liver of a patient who has seemingly recovered from his disease. We recommend avoidance of liver transplants from donors who are positive for anti-HBs and anti-HBc.

Mercury poisoning associated with hepatitis-B immunoglobulin.

as a preservative. We encountered mercury toxicity, in a patient who received high-dose immunoprophylaxis. A 44-year-old man with decompensated cirrhosis from hepatitis B underwent liver transplantation. He received 50 mL HBIG (HyperHep, Miles Inc, Cutter Biological, Elkhard, Indiana, USA) during operation, 50 mL postoperatively and on days 2 and 3. On day 4, he became hepatitis-B surface-antibody (HBsAb) positive, and was put

The domino transplant: transplant recipients as organ donors.

The success of solid organ transplantation is limited by ongoing problems with organ availability. The use of extended cadaveric donors as well as the use of living donors are both strategies used to overcome this shortage. One group of potential donors that has not been previously reported are those who have previously received an organ transplant. This type of transplant was first described as a domino transplantation of heart-lung and heart (1). A combined heart-lung transplant was performed in a patient with end-stage lung disease, but who still had adequate heart performance. The normal heart of this heart-lung recipient was then transplanted into a second patient with end-stage heart disease. In similar types of procedures, the successful retransplantation of a liver allograft from a liver recipient who suffered brain death has been described, as well as retransplantation of a renal allograft (2, 3). The transplantation of kidneys from a heart transplant recipient who suffered brain death has also been reported (4). To obtain a better understanding of the scope and results as such procedures, we performed a comprehensive review of the United States experience (5).

Leukocyte response to thymoglobulin or Atgam for induction immunosuppression in a randomized, double-blind clinical trial in renal transplant recipients

EVENTS surrounding the renal transplant procedure and initial hospitalization are important determinants of long-term allograft function. The initial immunosuppressive regimen may have a significant impact on these events, but the optimal immunosuppressive strategy for renal transplant recipients is not known. “Induction immunosuppressive therapy” generally refers to the use of antilymphocyte antibodies at the time of transplant. The theoretical advantages are: (1) avoiding the use of cyclosporine in the immediate posttransplant period and thus avoid vasoconstriction and (2) blocking T-cell activation and/or other immune cell function at the time of transplant. These combined effects may improve early allograft function, delay or prevent rejection, and improve long-term allograft survival. Induction therapy, however, may be associated with increased risk for cytomegalovirus (CMV) disease, and posttransplant lymphoproliferative disease (PTLD). In a recent randomized, double-blinded, multicenter clinical trial, thymoglobulin (SangStat Medical Corporation, Menlo Park, Calif) was found to be more efficacious than Atgam (Pharmacia & Upjohn, Kalamazoo, Mich) for the treatment of rejection. It was felt that this benefit might be due to the more profound and longer duration of T-cell depletion seen with thymoglobulin than with Atgam. To further evaluate this phenomenon, we performed a randomized, double-blind clinical trial for the prevention of acute rejection (induction) and analyzed T-cell subsets, absolute lymphocytes, and total white blood cell counts during the induction period and for 1 year following transplantation.