Lars-Erik Gelin

The Cadaveric Kidney in Clinical Transplantation

(1) Forty-eight kidney transplants obtained from 37 cadaveric donors between 13 and 82 years of age were analyzed with regard to influence of donor age, warm and cool ischemia time, onset of function and later course. (2) Short warm ischemic period was of importance for early onset of function. Function was obtained after warm ischemic periods up to 60 minutes. (3) A simple perfusion technique with cool 5% Rheomacrodex solution was used and found effective to obtain a bloodless and cool state of the organ. (4) Cool ischemic period up to 7 hours was compatible with function and did not delay the onset of function. (5) Our method of preservation enabled kidneys to be transported from distant hospitals.

Fifty Uremic Patients Treated with Renal Homotransplantation

Fifty uremic patients were treated with kidney homotransplantation between January 1965 and August 1967. Twenty-three patients received a kidney from a living donor, twenty-seven from a cadaveric donor. Six patients had to be retransplanted because of failure of the first transplant. At the present time 34 patients are alive. Three of these are on hemodialysis, the others have functioning transplants. The general condition and level of activity of these patients is on the whole very good. The results are discussed particularly with regard to the type of donor and the age of the recipient, and the causes of death.

Blood Flow in Kidney Transplants: A Clinical Evaluation of the 133Xenon Method

(1) The xenon method has been used to measure renal blood flow in 60 of the first 67 kidney transplants carried out in this department. (2) The method has proved to be of definite clinical value as a check of the perfusion of the kidney at the time of transplantation. (3) Persistently low flow values or values that decline markedly during the course of the operation are bad prognostic signs. With a flow value below approximately 100 ml/min/100 g there has been no eventual function. (4) A high flow value has been associated with either immediate or later renal function.

Urologic Complications in Renal Transplantation

Complications from the urinary tract occurred in 28 out of 67 renal transplantation patients with functioning transplants. That most commonly recorded was urinary leakage (17 cases). The complications were not more frequent in recipients of cadaveric kidneys than in those receiving living donor kidneys, but the consequences were more severe in the former group. Three of these patients lost the kidney as a result of hemorrhage or infection due to leakage, and two of them later died. No such sequels to leakage were encountered in the living donor group.Urinary leakage was more common when a pelvoureteric or uretero-ureteric type of anastomosis had been constructed than when the ureter had been implanted into the bladder.Urinary outflow obstruction occurred early in five and late in three cases, and was successfully corrected. Necrosis of the recipientss ureter occurred in two cases, leading to a fatal outcome in one, and the ureter of the transplanted kidney became necrotic in one case. The importance is s...