Ralph Shackman

POSSIBLE AIRBORNE SPREAD OF SERUM-HEPATITIS VIRUS WITHIN A HÆMODIALYSIS UNIT

Abstract An outbreak of Australia (Au) antigen-positive hepatitis in a haemodialysis unit seems to have been due to a specific incident, when a considerable amount of Au-antigen-positive blood was spilled. If the reasoning presented is correct, then haemodialysis units will have to take precautions against the airborne spread of the serum-hepatitis virus.

LATE URINARY-TRACT INFECTION AFTER RENAL TRANSPLANTATION

Abstract Urinary-tract infection occurring three months after renal transplantation was studied in 52 patients. The incidence of infection was 83% in females and 43% in males. When the primary diagnosis was chronic pyelonephritis the infection-rates were significantly greater than with other end-stage renal diseases. Since there was no evidence that these infections affected the function of the transplanted kidney, a conservative approach in the management of such patients is recommended.

HYPERTENSION IN PATIENTS ON REGULAR HÆMODIALYSIS AND AFTER RENAL ALLOTRANSPLANTATION

Abstract The blood-pressure in a group of forty patients on a renal replacement programme for at least 5 months (mean period 17 months) has been investigated. Sixteen had been on regular intermittent haemodialysis and twenty-four had been treated by renal allotransplantation. Transplantation provided better results in respect of the blood-pressure. Bilateral nephrectomy in patients on dialysis and after transplantation is recommended for patients with persistent hypertension. In cases where hypertension persists in patients after transplantation and nephrectomy, chronic rejection or stenosis of the arterial anastomosis are usually responsible.

The diagnosis of rejection of renal allotransplants in man.

Abstract The changes in eight simple laboratory determinations on blood and urine in 20 rejection episodes after renal allotransplantation have been analysed. The most significant changes were a fall in the 24-hour urinary urea and osmolar excretion; these were also the earliest and most reliable evidence of a rejection episode. Changes in 24-hour urine volume and platelet-count were also significant but were harder to evaluate. In all rejection episodes there was a significant decrease in creatinine clearance which returned to previous levels after treatment. The changes in blood-urea, 24-hour urinary protein, and sodium excretion were neither early nor significant.

FACTORS INFLUENCING EARLY FUNCTION OF CADAVER RENAL TRANSPLANTS

Abstract 33 cadaveric renal transplantations have been analysed with respect to the influence of donor ventilation, donor hypotension, and ischaemic times on the onset of function. Provided antemortem donor hypotension does not exceed 1 hour, the transplanted kidney functions within 4 days even when the warm ischaemia has been 2 hours. However, if donor hypotension exceeds 6 hours, the onset of function is likely to be delayed and dialysis will be required.

PRELUSIVE SKIN GRAFTS IN LIVE-DONOR KIDNEY TRANSPLANTATION

In recipients receiving oral azathioprine (50 mg. a day) the fate of skin grafts taken from live human prospective kidney donors correlates well with the outcome of kidney transplantation from the same donors. Correlation between the fate of skin grafts and HL-A serotyping is not nearly as good except in the case of complete HL-A identity. There is little or no correlation between the mixed-lymphocyte-culture test and the fate of skin grafts and the outcome of kidney transplantation. When the degree of compatibility does not exceed one haplotype the results of live human-kidney transplantation can be significantly improved if the fate of a preliminary skin graft from the prospective kidney donor is used as an index.