Lynn H. Banowsky

Post-renal transplant calciphylaxis: successful treatment with parathyroidectomy.

Calciphylaxis occurs in renal transplant patients more frequently than in chronic hemodialysis patients. It can occur in a patient with normal renal function who is also normocalcemic. Early parathyroidectomy can lead to healing of the skin lesions and prevent death of sepsis.

Plasmapheresis—Adjunctive Treatment for Steroid-Resistant Rejection in Renal Transplantation

Plasmapheresis was used to treat steroid-resistant rejection in 32 of 154 patients (21.1 per cent) receiving renal allografts during a 3 1/2-year interval. The 2-year actuarial patient and allograft survival rates for the 32 patients were 93.3 plus or minus 5 and 56.9 plus or minus 9 per cent, respectively. Mean patient followup was 18.8 months. No immunologic rebound was noted in any of the 19 patients who responded initially to plasma exchange. Although 14 of these 19 patients had peak creatinine levels of 4 to 14.5 mg. per cent during the rejection reactions significant and sustained improvement in renal function was noted. This was not a controlled trial but the results are sufficiently encouraging to warrant continued evaluation of plasmapheresis as a therapeutic adjuvant in the treatment of humoral or steroid-resistant rejection.

Upper gastrointestinal bleeding following renal transplantation

Upper gastrointestinal bleeding has been shown to be a common complication of renal transplantation and one which carries a significant risk of mortality. In a retrospective review of 200 consecutive renal transplants in 194 patients, we found an incidence of only 6 per cent and a mortality rate of 8.3 per cent. Allograft survival in this group of patients was 58 per cent. These results are the product of careful preoperative evaluation, close attention to the patients for early signs of bleeding, and aggressive diagnostic and therapeutic intervention at the first evidence of bleeding. We also report an association of hypercalcemia with post-transplant upper gastrointestinal bleeding, with cessation of bleeding after parathyroidectomy.

Effect of Pretransplant Blood Transfusions and Splenectomy on Renal Allograft Survival in the Lewis Rat

Both pretransplant blood transfusions and pretransplant splenectomy have been shown to improve renal allograft survival in humans and experimental animals. A study was undertaken using the Lewis rat to determine if any combination of pretransplant splenectomy and pretransplant blood transfusions exerted either a synergistic or deleterious effect on renal allograft survival. Pretransplant splenectomy and pretransplant blood transfusions used singly significantly prolonged renal allograft survival. Pretransplant splenectomy followed by 3 blood transfusions also significantly prolonged renal allograft survival. This finding implies that secondary sites of suppressor cell activity, for instance lymph nodes, can be stimulated by blood transfusion and produce prolonged allograft survival in the absence of the spleen. No combination of pretransplant blood transfusion and splenectomy was synergistic. In fact, the group that had pretransplant transfusions followed by splenectomy had allograft survival no different from the control group.

Basic microvascular techniques and principles

This article will discuss the advantages and disadvantages of the various types of optical magnification currently available. The instruments necessary for performing most operations will also be presented. Attention will be focused on the physical properties and technical considerations of microvascular anastomosis. The principles and techniques employed for joining small blood vessels are almost always valid and transferable to reconstructive surgery of other small tubes such as the ureter, bowel, etc.

Pretransplant bilateral nephrectomy and adjuvant operations

Pretransplant bilateral nephrectomy by the posterior approach has been associated with minimal morbidity and mortality. Unfortunately the posterior approach is not applicable to all patients, e.g., patients with polycystic renal disease or patients who need simultaneously another intraperitoneal adjuvant operation such as splenectomy or vagotomy and pyloroplasty. This article presents 34 patients who had a transperitoneal bilateral nephrectomy and 29 other concurrent adjuvant operations. Morbidity and mortality are comparable to that reported for simple bilateral nephrectomy performed posteriorly. The reduction in morbidity and mortality was believed to be due to a careful application of the basic principles of surgical care and an appreciation of the special problems posed by patients on chronic hemodialysis. Perioperative care will be discussed in detail.

Hypercalcemia-induced upper gastrointestinal bleeding after renal transplantation

Hypercalcemia is common in patients after renal transplantation and may stimulate gastrin hypersecretion with associated peptic disease. We report on 2 patients with hypercalcemia and life-threatening gastrointestinal hemorrhage controlled by subtotal parathyroidectomy. Retrospective review of our last 10 patients with gastrointestinal hemorrhage revealed that all of those with normal renal function had elevated serum calcium levels. Because of the increased mortality associated with gastrointestinal hemorrhage in renal transplant patients (43%), patients prone to development of hypercalcemia may benefit from early subtotal parathyroidectomy.

Selective posttransplant splenectomy in recipients of cadaveric renal allografts

La splenectomie est decidee apres la transplantation renale chez 11 receveurs de rein de cadavre, au moment ou apparait la leucopenie. Les resultats sont encourageants: correction de la leucopenie, tolerance de doses plus elevees de cytotoxiques, suivie des malades et des greffons egale a celle constatee lorsque la splenectomie est faite avant la greffe de rein

Patient Survival In Cadaveric Renal Transplantation: Report From A Small Center

Recipients of cadaveric kidney transplants before 1975 had a 1-year mortality rate (30 per cent) approximately 3 times higher than patients on chronic hemodialysis (10 per cent). Patient survival was no better in large than in small transplant centers. Since 1975 several large and experienced transplant centers (more than 500 transplants) have reported improved patient survival rates (90 per cent). We herein document that a small transplant center (less than 200 transplants) can achieve patient survival rates that are equivalent to larger transplant centers.

New arterial cannulation techniques in cadaver kidney preservation

Abstract A technique is proposed for the perfusion of cadaveric kidneys to minimize damage to the renal artery.