T.J. Wheatley

The relative influence of delayed graft function and acute rejection on renal transplant survival

Three hundred and eight cadaveric renal transplants were analysed to establish the effects of acute rejection in the first 90 days and delayed graft function (DGF) on graft outcome. There were 120 patients (39%) with no DGF and no rejection (group 1), 101 patients (33%) with rejection but no DGF (group 2), 41 patients (13%) with DGF but no rejection (group 3) and 46 patients (15%) with both rejection and DGF (group 4). The actuarial 4-year graft survival rates for groups 1,2,3 and 40.4%, respectively. The acute rejection rate was 101/221 (46%) in patients with initial graft function compared with 46/87 (53%) for those with DGF (χ2=1.02, P=0.31). Cox stepwise logistic regression analysis demonstrated that DGF was a more powerful predictive factor for poor graft survival (P=0.001) than acute rejection occurring in the first 90 days post-transplant (P=0.034). Further efforts at improving graft outcome should concentrate on reducing the incidence of DGF.

Work‐load generated by the establishment of a non‐heart beating kidney transplant programme

The work-load generated by a non-heart-beating donor (NHBD) kidney transplant programme over a 3-year period is reported. A total of 73 referrals were made, 64 from the Accident department and 9 from the wards. Organ procurement was performed in 24 cases (33%) and resulted in the retrieval of 44 kidneys. Reasons for failure to achieve organ procurement were: refused consent (n=13; 18%), relatives unavailable to ask for consent (n=9; 12%), technical problems with catheter insertion or perfusion (n=10; 14%), transplant staff unavailable (n=1; 1%), long asystolic period (n=8; 11%) and donor unsuitable for other reasons (n=8; 11%). Of the 44 kidneys retrieved, 30 were transplanted locally, 8 were transplanted at other United Kingdom centres and 6 were discarded. Locally transplanted NHBD kidneys represented 21% of the total transplant programme during the time period under study. We conclude that NHBD kidneys are a good source of additional organs for transplantation, but only one-third of referrals result in a successful procurement procedure. Moreover, the setting up of a successful programme is labour-intensive and requires a highly committed staff.

Transfusion-induced immunosuppression: Abrogation by leucodepletion

B LOOD TRANSFUSION causes a nonspecific downregulation of immune function and, although the mechanism of this is as yet unclear, it is likely that the HLA material present on the donor leucocytes is invo1ved.l This transfusion effect may have implications in the field of cancer surgery as a decrease in the host’s immune function at the time of resection of a tumour, when malignant cells are being shed into the circulation, may increase the likelihood of local and metastatic recurrence. A variety of studies have shown perioperative blood transfusion to be a poor prognostic indicator for cancer patients undergoing surgery, while others refute this.2x3 This study was designed to study the hypothesis that transfusion of leucodepleted blood at the time of major surgery results in less immunosuppression than standard blood.4