Magnusson G

Living related kidney donors: complications and long-term renal function.

SUMMARY Sixty-two living related kidney donors were nephrectomized ring a 10-year period. The overall complication rate was, most complications being minor. Among the major nplications was one patient with pulmonary embolism and see patients with hepatitis. One female donor suffered a choneurotic reaction following rejection of the donated lney and she is still away from work, more than 2 years yaer. The other 61 donors were back to work within 2 to 18 ean 8) weeks. The mean serum creatinine levels increased μm 0.95 preoperatively to 1.15 mg/100 ml at the followup mination, which took place between 6 months and 9 years yaer nephrectomy. The mean increase in serum creatinine is higher in donors above 50 years of age (P< 0.02). The an creatinine clearance of the whole group decreased from to 90 ml/min. The mean increase in size of the remaining lney was 22%. Donor nephrectomy is a safe procedure with serious complications and the prognosis for the recipient excellent. Therefore, we consider transplantation from a nily member to be the treatment of choice in terminal mia.

DRAINAGE OF THORACIC DUCT LYMPH IN RENAL TRANSPLANT PATIENTS

SUMMARY Lymphocyte depletion by drainage of lymph via a thoracic duct fistula was accomplished in 51 renal transplant recipients as an adjunct method for immunosuppression. The duration of lymph flow varied between 2 and 53 days and the total drained lymph volume between 1 and 168 liters. The graft survival of these patients was compared to that of a control group of patients undergoing transplantation during a similar period. The followup period was 2–6 years. In patients receiving transplants from living related donors, no beneficial effect of lymphocyte depletion was demonstrated, probably because of the satisfactory graft survival among the control patients (84% at 1 year). However, in recipients of cadaveric kidneys, a significantly higher 1-year graft survival was achieved in the lymph-drained patients. Drainage for more than 30 days and of more than 20 liters improved the results. Additional suppression by thymectomy and institution of antilymphocyte globulin suggested that the best treatment would be a combination of both these measures with lymph drainage continuing for more than 30 days. Infection around the thoracic duct cannula occurred in 5 patients, necessitating removal of the cannula in 2. Two patients developed septicemia. In one of them the infection originated from an infected incisional wound and in the other probably from reinfusion of contaminated lymph plasma. Two other patients developed malignant tumors 23 and 58 months after transplantation, respectively. It is felt that lymphocyte depletion by lymph drainage is an effective supplementary method of immunosuppression to enhance graft survival in recipients of cadaveric renal transplants.

Radiorenography in Clinical Transplantation

I131-hippuran renography was performed in connection with 21 homologous kidney transplantations in man. A total of 348 renograms were obtained and have been compared with the clinical course.The post-operative renograms had a normal appearance when ischaemia lasted less than 42 minutes. Longer ischaemia times first caused the excretion phase to disappear, giving an accumulation curve. The uptake phase was considerably more resistant, being present even when ischaemia lasted more than 6 hours.The presence of an uptake phase, however small, implies that blood is reaching the renal cortex. This provides a convenient indicator of circulation in the transplant. The excretion phase of the renogram is affected by all factors, such as impaired urinary production and urinary flow.The renogram generally displays typical changes in conjunction with rejection, sometimes before other symptoms can be detected. Renograms taken at an early stage can be used to distinguish between an oliguria due to imminent rejection and...

Kidney Transplantations, 1964–66, at Serafimerlasarettet and St. Erik's Hospital, Stockholm

This paper is an account of the cases of kidney transplantation undertaken at Serafimerlasarettet and St. Eriks hospital from April 1964 to April 1966. A total of 21 homologous kidney transplantations were made on 20 patients. The donors were 12 relatives, 2 living non-related and 7 cadavers. At the end of the follow-up examination, 11 patients were still alive with observation times of 1/2 to 2 1/2 years. In the 10 cases investigated, the renal function—measured as the creatinine clearance in 24 hours—gave a mean of 54 ml/min.The transplant was implanted in the pelvis, the vessels being anastomosed to the hypogastric artery and the external iliac vein. The ureter of the transplant was anastomosed to the recipients urinary bladder (19 cases), ureter or renal pelvis. Urinary fistula developed in the latter cases.The immuno-suppressive treatment comprised splenectomy (3 cases), drainage of the thoracic duct lymph, cytotoxica and steroids. One case with a state resembling hepatitis was treated for 31 days ...

A Study of Normal and Atretic Follicles with Autoradiography

For a long time it has been accepted, that two processes pass side by side a t the development of the ovarian follicles, namely growth and retrogression. As a result only a few follicles reach full maturity, while most of them at some point of their development are overtaken by retrogressive changes. The methods of studying the follicular system are, for example, counting the follicles a t different stages of development and of different sizes, counting the mitoses and classifying them into “normal” and “atretic” follicles. If atresia is present or not will be decided by a number of histological signs which are rather indefinite. B 1 o c k (195 I , 11) has collected and enumerated the histological signs of retrogression. Because the histological signs of retrogression are difficult to judge and because full agreement has not k e n reached on the changes which should be regarded as significant of atresia, histological investigations are always uncertain and not entirely objective. In an earlier work on autoradiography with Pa2 of the rabbit ovary (0 d e h l a d , 1951, I ) it was observed that atresia of follicles seemed to be associated with a relatively small accumulation of Pa2. This question has been subjected to a more careful study