Russell K. Lawson

Renal transplantation in pediatric patients.

Thirty-five transplants have been performed in 29 children, 1 week to 16 years old. Of these patients 79 per cent are surviving from 9 months to 14 years post-transplantation. Eighteen of these patients have required different surgical procedures for transplantation than adult patients. Immunosuppressive therapy has been essentially the same as in adult patients. A striking difference between the living related donor and the cadaver donor transplant functional survival as seen in this series is unexplained at the present time. Linear growth has been good in those children who have required minimal doses of corticosteroids to maintain adequate renal function.

Human chromosome uncoiling and dissociation

The treatment of human chromosomes with solutions of low ionic strength produces changes in their characteristic morphology, in particular a 0.01 M solution of KCl produces uncoiling of the primary coils of the chromosome; and when the metaphase cells are allowed to rupture by air drying without fixation, the uncoiled chromosomes will dissociate into their constituent longitudinal subunits. The action of the monovalent salt KC1 is reduced in the presence of the divalent salts CaCl2 or MgCl2; and if the proper balance between the divalent and monovalent salts is maintained, the uncoiling and dissociation of the chromosomes is entirely prevented.

THE PROLONGATION OF CANINE RENAL HOMOGRAFT FUNCTION USING ANTILYMPHOCYTE SERUM AS AN IMMUNOSUPPRESSIVE AGENT

Antilymphocyte serum has been found to be an effective immunosuppressive agent in prolonging canine renal homograft function. This study is based on the results of administration of antilymphocyte serum to 10 normal dogs without renal homografts and 13 dogs with renal homografts. Studies on the specificity of the antiserum are also reported.

Renal Transplantation in Cystinosis

Three children from 6 1/2 to 10 years old received kidney allografts from their parents 2 1/2 to 4 1/2 years ago. Renal function has been stable and the patients have been doing well. Studies of renal tubular function as well as morphologic studies by light and electron microscopy, and microdissection of renal tubules fail to reveal evidence of recurrent disease in the allografted kidneys.

An Analysis of 100 Primary Cadaver Kidney Transplants

A multifactorial analysis of 100 consecutive first cadaver kidney transplants was done to document the current status of this treatment for end stage renal disease and to determine the influence of the following variables on kidney losses owing to rejection: splenectomy, pre-transplant transfusions, transfusion at the transplantation, recipient sex, pre-transplant nephrectomy, donor and recipient A, B or O blood group, human leukocyte A and B antigen mismatches, kidney preservation method, donor treatment with methylprednisolone and cyclophosphamide, recipient treatment with antilymphocyte serum or antilymphoblast globulin and a low dose of steroid treatment for rejection. Pre-transplant splenectomy for leukopenia, 5 or more pre-transplant blood transfusions and pre-transplant transfusions without development of circulating cytotoxic antibodies significantly reduced kidney losses owing to rejection (p less than 0.05)., A low dose of steroid treatment for rejection resulted in a trend towards improved patient survival without sacrificing kidney graft survival. Clinical studies demonstrating decreases in kidney graft rejection should be controlled for pre-transplant blood transfusions and, possibly, for pre-transplant splenectomy for hypersplenism.

The Effect of Human Serum on 3H-Thymidine Incorporation in Human Prostate Tumors in Tissue Culture

Human prostatic tumors, 4 adenomas and 4 adenocarcinomas, were established in tissue culture. We used the incorporation of 3H-thymidine into deoxyribonucleic acid as a measure of cell activity to compare the effects of supplementing the culture media with human or fetal calf serum. 3H-thymidine incorporation was greater with human serum, with up to 120 per cent increase observed. The addition of dihydrotestosterone (10(-8)M.) did not enhance or inhibit 3H-thymidine incorporation.

Extracorporeal renal artery repair and autotransplantation

Abstract Seven renal artery lesions in 6 patients have been corrected by extracorporeal repair of the renal artery followed by autotransplantation. Short-term renal presevation was accomplished using readily available perfusion solutions. Six of the seven procedures were technically successful. One of the six technically successful procedures was a functional failure, with the patient ultimately receiving a cadaver kidney transplant. Five of the 6 patients are well and free symptoms, and 1 patient has recurrent disease in branches of the autotransplanted kidney and is again hypertensive.

Role of splenectomy in renal transplantation

One hundred sixteen renal transplants in 99 patients were reviewed. Patients were divided into four groups: 53 live donor recipients with pretransplant splenectomy, 13 nonsplenectomized live donor recipients, 20 cadaver recipients with splenectomy, and 30 nonsplenectomized cadaver recipients. Nonsplenectomized live donor recipients had fewer rejection episodes per month of graft function (p < 0.005). Serum creatinine in functioning grafts showed no differences between splenectomized and nonsplenectomized patients. In 73 splenectomized patients there were 14 related septic and/or thromboembolic complications, 6 fatal. Mean daily azathioprine dosage was greater in splenectomized patients (p < 0.005). There were no hyperacute rejections of second transplants in splenectomized patients, while 2 occurred in 8 nonsplenectomized patients. Splenectomy prior to renal transplantation did not decrease the number of rejection episodes per month of graft function and was associated with a higher rate of septic and thromboembolic complications.