Seiji Kunikata

The significant effect of HLA‐DRBl matching on acute rejection in kidney transplants

Abstract  The object of the present study was to confirm the HLA‐DRBI matching effect on rejection crisis, its severity, and kidney graft survival based on genotyping. Ninety‐four renal allografts were included in this study. DNA typing of HLA‐DRBI was performed by the polymerase chain reaction sequence‐specific oligonucleotide method. The incidence of acute rejection within 6 months following transplantation, the frequency of OK administration for steroid‐resistant rejection, histopathological findings, and graft survival rate were compared between the DR ‐matched (n = 23) and DR ‐mismatched (n = 71) groups. Four acute rejections occurred in the DR ‐matched group (incidence; 17 %) and 40 in the DR ‐mismatched group (56 %). In the DR ‐matched group, the incidence of acute rejection was significantly less frequent than that of the DR ‐mismatched group (P < 0.005). In the DRBI‐matched group, only one patient received OK administration (4 %), in contrast to 16 of 71 patients in the DR ‐mismatched group (23 %). The use of OK was significantly less frequent in the DR ‐matched group (P < 0.05). Histopathological findings from biopsy specimens showed no constant distribution of pathological grades of acute rejection according to DRBI matching in the present study. The graft survival rate in the two groups did not differ significantly, but the graft survival rate in the DR ‐mismatched group had a tendency to decrease as the grafts survived longer. In conclusion, the results of the present study confirm that HLA‐DR matching has marked beneficial effects on kidney transplants through reduction of the acute rejection rate and decrease of the severity of rejection, and suggest that improvement of graft survival will be obtained through kidney allocation to a DR ‐matched recipient.

Assessment of the long-term results of ileocecal conduit urinary diversion.

We reviewed our 12.5-year experience with ileocecal conduit (ICC) and report the long-term results of 147 cases of ICC compared with those of our 102 cases of ileal conduit (IC). We usually performed ICC following total cystectomy for carcinoma of the bladder, while we chose IC in cases of high stage or recurrent malignancies. The average follow-up period was 41.7 months in the ICC group and 28.8 months in the IC group. The postoperative mortality (6.1%) and the incidence of early complications (21.1%) in the ICC group were comparable with the reported incidences for IC. In the later period, stomal problems were most frequently encountered. Urinary tract complications are important because they affect renal function in the course of a long period of time. Excretory urogram showed a satisfactory result and serum creatinine remained within the normal limits even in patients followed up for a long time in both groups. The incidences of pyelonephritis and urinary stones in the ICC group were 13.6 and 5.4%, respectively. We had expected a much lower incidence of these complications and ICC could not cover all the drawbacks of IC. However, at present, there is no ideal or perfect method of urinary diversion, ICC should be one of the acceptable options which has a satisfactory long-term result.

Clinicopathological Study on End-Stage Reflux Nephropathy in Renal-Transplanted Children

Five children with end-stage reflux nephropathy underwent kidney transplantation at our clinic. Reflux nephropathy was studied clinically and histologically. All children had proteinuria before starting hemodialysis, and hypertension was present in 2 cases. Three children underwent antireflux operations prior to transplantation. The original kidneys exhibiting reflux were removed during renal transplantation. All original kidneys exhibited atrophy and scarring. Focal and segmental glomerulosclerosis was found in 4 cases. PAS deposition in the interstitium, suggestive of Tamm-Horsfall glycoprotein, was found in all cases. No recurrent signs of focal and segmental glomerulosclerosis have been found in the children who have been followed up from 1 to 6 years after transplantation.