Satya N. Chatterjee

Successful Renal Transplantation in Patients Positive for Hepatitis B Antigen

Abstract We examined the effect of hepatitis B antigenemia on the outcome of renal allografts. Sixteen of 116 renal-allograft recipients were hepatitis antigen (HBs Ag) positive before transplantation. These HBs AG-positive patients had a graft survival of 60.3 and 30.2 per cent at one and two years. The mortality in the positive group was 18.9 per cent, and that in the negative patients was 19.8 per cent. The results of post-transplant hepatic tests in the two groups were similar. In seven other patients HBs Ag positivity was detected after transplantation. They did not differ from other patients with transplants in either hepatic or graft function. The mean period of post-transplant HBs Ag positivity was 16.5 months in this group of 23 patients. HBs Ag antigenemia acquired before transplantation or in the post-transplant period could not be correlated with hepatic dysfunction or poor graft survival. (N Engl J Med 291:62–65, 1974)

Protective effect of allopurinol in renal ischemia

We have confirmed earlier findings that treatment with allopurinol offers some protection to the kidney from ischemic damage caused by total interruption of renal circulation. With this evidence, a clinical trial is warranted, particularly when periods of warm ischemia are unavoidable.

Vascular access for chronic hemodialysis using modified bovine arterial graft arteriovenous fistula

Abstract Modified bovine arterial graft arteriovenous fistulas were used for access to the circulation for hemodialysis in thirty-six patients whose forearm vessels were unsuitable for Brescia-Cimino fistulas. Twenty-seven of thirty-one thigh fistulas and three of five forearm fistulas are still functioning well. Most of the complications were minor and may be preventable. Thigh heterografts provided excellent blood flow for dialysis and have been the most successful alternative for patients who have repeated shunt or fistula failures.

PROSPECTIVE STUDY OF THE PREVALENCE AND SYMPTOMATOLOGY OF CYTOMEGALOVIRUS INFECTION IN RENAL TRANSPLANT RECIPIENTS

To determine the incidence and symptomatology of cytomegalovirus (CMV) infection in renal transplant recipients, we followed 40 patients prospectively for 5 to 24 months after operation. As judged by the serological change and virus isolation from blood and/or urine, the infection rate for the entire group was 82% (33 of 40 patients). Two types of infection were recognized: primary infection that occurred in 3 patients, and reactivation infection that occurred in 30 patients. Twenty-one patients were asymptomatic and 12 were mildly symptomatic. Four had mild hepatic dysfunction; two had the CMV mononucleosis syndrome associated with mild to moderate deterioration of renal function. Two patients had hyperglycemia. One patient who reached a CMV antibody titer of 1:32,768 was totally asymptomatic other than fever of short duration. CMV-induced pneumonitis or retinitis was not noted, and there was no mortality from CMV infection in our patients. Factors which may be associated with the absence of severe manifestations of active CMV infection in these patients are discussed.

Effect of cytosine arabinoside on herpes virus infection in renal allograft recipients

Cytosine arabinoside (Ara-C) was used for treatment of severe symptomatic cytomegalovirus (CMV)-herpes infections that were seen in nineteen of 174 renal allograft recipients. Ara-C was administered by continuous intravenous infusion at a mean dose of 35 mg/m2 daily for three to four days. Side effects were few and minor in nature. All cases of herpes simplex and herpes zoster, which usually have a prolonged and sometimes unfavorable course in immunosuppressed patients, cleared promptly with no recurrence. All nine patients, except one who had CMV infection with the symptom complex of fever and retinitis or pneumonitis, responded satisfactorily. In the three patients in whom the CMV titers were available, there was a significant decrease in titer within two weeks after treatment. This pilot study of Ara-C in treatment of CMV-herpes infections in immunosuppressed renal allograft recipients suggests a degree of efficacy and safety in the drug that would justify a carefully designed, controlled study.