Netar P. Mallick

Posttransplant antidonor lymphocytotoxic antibody production in relation to graft outcome.

Serial serum samples from 266 recipients of primary renal allografts were monitored posttransplant for the presence of panel reactive lymphocytotoxic antibodies (PRA). The minimum posttransplant follow-up period was 18 months. Patients were classified according to whether or not they produced PRA before and/or after transplantation. The groups were as follows: PRA negative before and after transplant, -/-, 171; PRA positive before and negative after transplant, +/-, 5; PRA positive before and positive after transplant, +/+, 27; PRA negative before and positive after transplant, -/+, 63. Actuarial graft survival at 1 year for each group was 81.3%, 100%, 70.4%, 47.6%, respectively. Fifty-five of the 63 -/+ recipients were retrospectively crossmatched with posttransplant sera against stored donor lymphocytes. Of these, 50 (91%) were posttransplant cross match positive, and 37 (67%) have lost their grafts. In 23 of the 26 cases where an anti-HLA specificity was defined, the antibody was directed against antigens present in the donor but not in the recipient. These results clearly indicate that the production of PRA in recipients of renal transplants is associated with antidonor reactivity and poor graft outcome. The fact that these PRA were often directed against donor HLA antigens emphasizes one of the hazards of mismatching for HLA at transplantation.

Evidence that matching for HLA antigens significantly increases transplant survival in 1001 renal transplants performed in the northwest region of England

In the 20-year period from March 1968 to March 1988, 860 patients received 1001 renal transplants in the Northwestern Regional Renal Transplant Unit at Manchester Royal Infirmary. Through a continuing policy of avoiding mismatches for HLA antigens and lymphocytotoxic antibody crossmatching, transplant survival rates were found to correlate with the degree of HLA-A and B antigen mismatching from 1968 to 1978 and with HLA-B and DR antigen mismatching from 1979 to 1988. Mismatching for HLA-B and DR antigens was also found to correlate with transplant survival in highly sensitized patients and in patients transplanted since 1981, the “cyclosporine era.” Recipients who were HLA-DR1 positive were found to have the highest graft survival compared to recipients negative for this antigen. In contrast, HLA-DR3 positive recipients had the poorest outcome. Transplants from HLA-DRw6 positive donors showed higher transplant survival rates than donor kidneys positive for any other HLA-DR antigen. A correlation of transplant survival with HLA-B and DR mismatching was seen whether kidneys were collected within our region or received through the UK Transplant Service. We conclude that avoidance of mismatching for HLA-B and DR antigens confers high transplant survival rates (91.1% at 5 years for 0 HLA-B and DR mismatches), and in order to achieve this rate for most recipients exchange of donor kidneys between transplant centers will be essential.

Relapsing Henoch-Schönlein syndrome with renal involvement in a patient with an IgA monoclonal gammopathy. A study of the results of immunosuppressant and cytotoxic therapy.

A 42-year-old female with IgA monoclonal gammopathy and Bence-Jones proteinuria suffered from recurrent episodes of Henoch-Schonlein syndrome and renal failure. The renal biopsy showed a diffuse proli

Twenty-one years survival with systemic AL-amyloidosis

AL-amyloidosis has a poor prognosis, typically with cardiac or renal failure ensuing some months after diagnosis. However, sporadically there have been reports of long-term survivors, either with unusual manifestations of amyloidosis, or after concerted chemotherapy to suppress the overt or occult pathological monoclonal plasma cell population responsible for the elaboration of immunoglobulin light chains. We report the case of a 46-year-old man who has survived 21 years after the histological diagnosis of renal amyloidosis was made, after he had presented with severe nephrotic syndrome. This patient was given intensive chemotherapy but came to end-stage renal failure some 10 years later, was dialysed for 1 year, and then was the successful recipient of a cadaveric renal transplant, which is working excellently some 10 years later, with little evidence of recurrent renal or systemic amyloidosis. There is renewed interest in therapy for systemic amyloidosis, and this case demonstrates that with this approach the prognosis can be more favorable than is commonly assumed.

Complete Clinical Remission and Subsequent Relapse of Bronchiectasis-Related (AA) Amyloid Induced Nephrotic Syndrome

Systemic amyloidosis normally has a dismal prognosis. However, there are several case reports of protracted survival, usually as a response to measures designed to retard the further deposition of amyloid fibrils. In AA amyloid, most commonly associated with inflammatory rheumatological, bowel, and chest diseases, such interventions have had some success, but the dramatic response of complete resolution of nephrotic syndrome as a result of the regular institution of postural chest drainage and antibiotic therapy, in the clinical context of bronchiectasis, has been previously reported only once. In both of our cases, after protracted remission, such therapy was abandoned by the patients, leading both to recurrence of nephrotic syndrome and also eventually to end-stage renal failure requiring dialysis.

Sclerosing Encapsulating Peritonitis and Other Complications of CAPD Peritonitis

Among 97 patients treated by CAPD for a mean of 10.5 months, the peritonitis rate was 1.9 episodes/patient years and 15 patients had serious complications of peritonitis prompting a change to hemodialysis. Complications included sclerosing encapsulating peritonitis, loss of ultrafiltration capacity, loss of peritoneal surface and recurrent peritonitis. The pathogenesis of these complications of peritonitis remains unknown but these sequelae impede long-term treatment by CAPD.

Late cellular rejection in renal transplant recipients

8 observations de rejet tardif (entre 10 et 127 mois) de type cellulaire interstitiel. Facteurs de risque probables: infections, immunodepression inadequate, disparite genetique

Successful renal transplantation of patients sensitized following deliberate unrelated blood transfusions.

One of the most powerful influences on cadaveric renal graft survival is the enhancing effect of blood transfusions from unrelated individuals (1, 2). However, the optimum number of transfusions required to achieve this effect remains controversial. Enhanced graft survival following only one or two transfusions has been observed (3), although graft survival has also been found to be better for multitransfused recipients (4). Extrapolating from their studies on mice, Wood et al. (5) suggested that only a very small volume of blood may induce the transfusion efect in humans. As the number of transfusion effect in humans. As the number of transfusions increases so does the risk of sensitizing the patient to produce lymphocytotoxic antibodies that may impair the chances of the patient receiving a crossmatch-negative kidney graft (6, 7). Thus the problem is to minimize the chance of sensitization while still maintaining the beneficial effect of blood transfusion.

Circulating Immune Complexes and the Treatment of Wegener’s Granulomatosis

Circulating immune complex levels have been measured using four different assay systems in 2 patients with Wegeners granulomatosis during active and inactive disease and during different treatments. C

Home CAPD Nurse—An Asset to a CAPD Program

In the Manchester region the home care nurse provided a valuable service for the patients by maintaining the vital link between home and hospital and achieving a significant reduction in the number of hospital visits. Her role made the out patient treatment of peritonitis more practicable and furnished immediate and close contact during times of difficulty for the patient. Her unique position allows insight into the patient’s family and social situation, giving the ability to envisage and resolve problems sooner than a hospital based team would be able. Patient reaction consistently indicated, particularly from the more vulnerable patients, that the provision of a home nurse was a welcome facility. We feel that the home CAPD nurse is an invaluable member of the CAPD team in any CAPD program but more so in a large one undertaking care of all types of patients but in particular those deemed high risk.