Zaki Shapira

Beneficial effect of lamivudine in recurrent hepatitis B after liver transplantation

Orthotopic liver transplantation (OLT) in patients infected with hepatitis B virus (HBV) is known to be associated with a high recurrence rate and poor prognosis. Interferon treatment in these patients offers little benefit and may lead to further complications. Lamivudine, the (-)enantiomer of 3-thiacytidine, a 23-dideoxynucleoside, is known to be a potent inhibitor of HBV replication in patients with chronic HBV infection. Three HBV-positive OLT patients were administrated lamivudine, 100 mg x 1 orally, for a period of at least 20 weeks, in an open, compassionate-use basis. All three patients were HBV DNA-negative before OLT. HBV reinfection occurred at a median time of 7 months (range, 6-9 months) after OLT, in spite of adequate immunoprophylaxis. All three patients had high serum transaminase levels (alanine aminotransferase [ALT], 103-324 U/L) and histologic evidence of recurrent HBV infection of the grafted liver, and HBV DNA was evident in the sera of all of them. Six weeks after lamivudine treatment, HBV DNA disappeared from the serum of all patients (detected by hybridization); by the 10th week, HBV DNA was also negative by polymerase chain reaction in two out of three patients. Interestingly, the one patient who was HBV DNA positive by polymerase chain reaction still has mildly elevated ALT levels, whereas the other two patients have normal ALT levels. We also noted that on the 5th week there was a transient elevation of serum ALT levels in two patients. No adverse effects or rejection episodes were noted. In conclusion, lamivudine is a beneficial and well-tolerated therapy in OLT patients with recurrent HBV infection. We are studying the effect of lamivudine in other patients and for a longer period of time.

Suicide by related kidney donors following the recipients' death

Two cases of suicide by related kidney donors following graft rejection and the death of the recipients are reported. It is concluded that psychiatric screening of the donor before transplantation is necessary in order to obtain information about past psychopathology, ambivalence involved in donating the kidney, psychological style, characteristic defenses and behavioral repertoire used to cope with anxiety and disappointed life circumstances. The data are necessary to assess the donors capability of accepting a possible failure of the transplantation procedure. A psychiatric evaluation after transplantation is indicated following graft rejection and death of the recipient to assess the development of depression and suicidal potential of the related donor.

Page kidney phenomenon in kidney allograft following peritransplant lymphocele

A case of kidney allograft dysfunction in a recipient with a prior lymphocele is described. We attribute it to a Page kidney phenomenon caused by a constrictive pericapsular fibrosis. Surgical exploration and excision of the fibrotic tissue were followed by the recovery of renal transplant function. To our knowledge, only 1 case of Page kidney in renal allograft due to peritransplant hematoma has been described in the literature.

Malacoplakia Presenting as a Pseudotumor of the Bladder in Cadaveric Renal Transplantation

Genitourinary malacoplakia in renal transplant patients is rare. We report a case of malacoplakia of the bladder, which presented as a vesical tumor.

In vitro induction of T suppressor lymphocytes in recipients of renal allografts by THF, a thymic hormone.

Lymphocyte subpopulations were determined in 13 patients, recipients of kidney allografts, 7 of them during an acute rejection episode (ARE). Monitoring of the T lymphocyte suppressor or T helper cells was performed by aid of the theophylline sensitivity test and the local xenogeneic graft-versus-host reaction (GVHR). An absence or a striking decrease of theophylline-sensitive T suppressor cells was found in all patients during ARE. Incubation of the lymphocytes of these patients with a thymic hormone, THF, raised the number of TS lymphocytes from nil or from a very low level to normal or above. The therapeutic use of THF in selected renal allograft recipients is proposed.

Scintigraphic evaluation of parenchymal malakoplakia in a transplanted kidney.

The scintigraphic evaluation of a rare case of parenchymal malakoplakia in a transplanted kidney is presented. Uptake of Tc-99m DMSA in the involved area was reduced and the Ga-67 uptake was increased.

Orbitorhinocerebral mucormycosis following kidney transplantation

Of 688 patients who underwent renal transplantation, three (0.44%) developed mucormycosis. The initial symptoms common to all of them were epiphora and periorbital pain. One patient had diabetes mellitus. All developed the serious complication while being treated for renal transplant rejection between the years 1980-85. At this time and until 1987, all cadaveric transplant recipients at our center routinely received azathioprine and high-dose steroids postoperatively; rejection episodes were treated with intravenous methylprednisolone 1000 mg/day for three days. In April 1987 the postoperative immunosuppression protocol was changed to cyclosporine and a tapering dose of prednisone, with rejection episodes treated with methylprednisolone 500 mg/day for three days, followed by anti T-lym-phocyte antibodies (OKT3, ATG) in resistant cases. It is concluded that the lack of new cases of mucormycosis after 1985 is related to the change in postoperative therapy and acute organ rejection regimen, mainly the reduct...

Lack of suppressor T cells in renal transplant recipients and activation by aminophylline.

Immunoregulatory T-cell subsets were determined in 16 patients after renal transplantation. Suppressor and helper T lymphocytes were isolated with the aid of theophylline according to the method described by Shore et al. [1]. The system model used for assessing the function of these subsets was the local xenogeneic graft-versus-host reaction (GVHR). Lack of suppressor T cells was found in 6 out of the 16 patients, all 6 in acute steroid nonresponsive rejection crisis. Four of these patients received aminophylline per os at a dose of 1000 mg/kg per day and the T-lymphocyte subsets were retested several days afterwards. Active suppressor T cells (TS) appeared in all 4 treated patients, paralleled by disappearance of rejection crisis and a dramatic decrease of serum creatinine levels. These findings suggest that the inactivation of the immunoregulatory suppressor subset, probably by the immunosuppressive treatment, may play an important role in acute rejection and that activation of this subset of T suppressors could be of beneficial effect and prevent renal rejection.