Jacques Corman

RECOVERY FROM “HEPATORENAL SYNDROME” AFTER ORTHOTOPIC LIVER TRANSPLANTATION

Abstract Three patients with progressive renal failure and advanced hepatic insufficiency due to cirrhosis of the liver underwent orthotopic liver transplantation. All three patients had immediate improvement in hepatic function and within two weeks after liver replacement regained nearly normal kidney function. However, the renal recovery was delayed in each case, and its course was not uniform. Plasma renin activity was high, and renin substrate was low before transplantation in one case in which these measurements were obtained; both returned to normal soon after liver replacement. (N Engl J Med 289:1155–1159, 1973)

Variations in Arterial Blood Pressure after Kidney Transplantation Relation to Renal Function, Plasma Renin Activity, and the Dose of Prednisone

The course of hypertension within the first 2 months after kidney transplantation was correlated with renal function, plasma renin activity (PRA), and the daily maintenance dose of prednisone in 18 homograft recipients. During acute rejection blood pressure (BP) closely correlated with PRA. Patients with normal homograft function showed an increase in BP early after transplantation which in most returned to normal 3-8 weeks later. In the latter group no correlation could be found between the level of BP and PRA, however the BP correlated closely with the dose of prednisone. These observations suggest that during acute rejection the increase in BP may at least partly be mediated by a renal pressor mechanism, whereas with normal renal function the high dose of glucocorticoids may play an important role in the development of hypertension.

Unsuccessful attempts to control hyperacute rejection of human renal homografts with F(ab') 2 and citrate organ pretreatment.

The presence of preformed cytotoxic antidonor antibodies in the serum of potential allograft recipients leads to the rapid destruction of the graft by the now well known events of hyperacute rejection (10, 21, 24-27). Experimental work in the past several years at our center and in other laboratories has been oriented to the solution of this difficult immunological problem, not only in the presensitized homotransplantation model but also in strongly incompatible xenograft combinations. Antibody and complement depletion (3-5, 7, 8, 13, 16, 19, 21, 23), or treatment by the chelating agents, sodium citrate (12, 14) and ethylenediaminetetraacetate (EDTA) (1), has been shown to delay hyperacute kidney rejection in both experimental models, whereas anticoagulation with heparin (15) or cobra venom (6) has yielded equivocal results. Even the most effective of these therapeutic procedures only delayed the destruction of the graft. More recently, encouraging results were obtained by several workers (11, 20, 22) with pretreatment of the organ with antidonor IgG fragments (F(ab′)2). It was suggested that F(ab′)2 fragments were protective by occupying the donor antigen receptor sites. Unsuccessful attempts to control hyperacute rejection in one of our patients who had preformed circulating cytotoxic antibodies are reported here, using homografts pretreated with sodium citrate or digested IgG.

Autopsy findings in a long-surviving liver recipient

IT has been a little more than five years since the first extended survival was achieved after human liver transplantation, and for that reason individual cases are still of special interest. For a...