[An improved treatment of allograft rejection. Rabbit antilymphocyte serum].
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Biomedical subjects
Publications and source records attributed to D Fries.
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In order to evaluate precisely the place of continuous ambulatory peritoneal dialysis in the treatment of chronic renal failure, it is important to find out whether this method may produce complications, mostly infectious, after renal transplantation. From April, 1979 to December, 1983, 419 renal transplantations were performed in our centre; 17 of these patients had previously been treated with peritoneal dialysis over a mean 13.5 months period, with 3.2 peritonitis/patient. The peritoneal catheter was left in situ for 4 to 16 weeks post-graft, so that the patients could easily be dialysed if needed; it was removed during transplantation in the only 3 cases of recent peritonitis. The only complications noted after transplantation were an episode of spontaneously reversible ascites and a peritoneal breach following reintervention on the renal region. This homogeneous series confirms that continuous ambulatory peritoneal dialysis does not constitute a contra-indication, let alone an obstacle, to subsequent renal transplantation. Indeed, it may be regarded as the first-choice method for patients in whom early grafting is envisaged on account of their immune status.
The study of 24-h urinary excretion proves to be quite interesting from a theoretical point of view on account of its topographic origin in the nephron and from a practical point of view to control renal transplant patients with favourable or unfavourable course. In both cases, the results we obtain are in accordance with that of blood creatinine assay and ratio N-acetyl-beta-D-glucosaminidase (NAG)/creatinine in urine. The prolonged study of serum THG concentration confirms the previous data regarding the outcome of renal grafts. Moreover, particularly low concentration rates probably imply the interference of factors such as: renal toxins or anti-THG autoantibodies.
We report a case of fulminant hepatocellular carcinoma discovered 50 days after renal transplantation. The recipient was a young Senegalese, hepatitis B virus chronic carrier. The pre-transplant check-up was normal, and the tumor was latent until its dramatic expression. Progression of hepatitis B liver disease occurs in immuno-suppressed renal transplant recipients, which often leads to chronic active hepatitis, cirrhosis and hepatocellular carcinoma, with a high risk of death due to liver disease. The early discovery of the tumor in this patient emphasizes the necessity for complete hepatic screening before transplantation in african, hepatitis B virus chronic carrier recipients. Moreover, the accumulation of risk factors for hepatocellular carcinoma: hepatitis B virus, food mycotoxins (aflatoxin), parasitic infestation and immunosuppression with transplantation is stressed.
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The authors report four cases of pregnancy in a series of 174 women who had undergone renal transplantation. In one case the pregnancy was complicated by a pre-eclamptic attack and premature delivery. A review of the literature shows that the risks to the mother and the kidney are marginal. The risk to the child, however, is more serious. Pregnancy in transplant patients is therefore a high-risk pregnancy requiring advance precautions and careful surveillance.
Rifampicin is considered as one of the most potent antituberculous agents and is often used in renal transplant recipients. However, acute cellular rejection episodes were observed when rifampicin was prescribed in 4 tolerant renal transplant recipients. Acute rejection occurred in 3 out of the 5 patients, despite doubled daily dose of steroids. First, rifampicin is an enzymatic inducer and accelerates steroid metabolism. Secondly, rifampicin per se is an immunosuppressive drug, as already proved in animals. Rifampicin interferes with the active mechanisms involved in specific transplantation tolerance. In conclusion, we recommend a very cautious use of rifampicin in kidney transplant recipients.
The authors report a series of 430 renal transplantations performed over five years. During this period, the surgical technique was modified to ureterovesical anastomosis. The urological complications--fistulae and stenosis--are discussed as a function of the site of the implantation, the position of the kidney, the type of anastomosis and the length of the ureter. The results show that transplantation in the iliac position gives rise to more complications than transplantation in the pelvic position. They also show that inversion of the superior pole of the kidney leads to a greater number of urological complications. In the series reported, ureterovesical anastomosis gave 6.7% of complications, against 12% for uretero-ureteral anastomosis, which also gave rise to a significantly larger number of fistulae. More detailed study of the series reveals a complication rate of 4.7% for ureterovesical anastomosis (out of 224 patients) against 4% for uretero-ureteral anastomosis, when the ureter was short (in both series). The dominant factor is therefore the length of the ureter; the longer it is, the greater the number of urological complications.
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From 1977 to 1982, 170 potential organ donors were referred to "a brain-death unit". A vast majority of these patients were provided by intensive care units of district general hospitals from Ile-de-France. This fact confirms the dispersion of potential organ donors and the usefulness of an organ-procurement structure based in an University Hospital. Its effectiveness is demonstrated by an harvesting rate of 58%, largely over the already published reports in case of absence of such a center. It is concluded that the adoption of this system by other hospitals would significantly increase the number of cadaver kidney grafts available for transplantation whereas actually the number of kidney grafts remains dramatically low in France.
A case of candida peritonitis during continuous ambulatory peritoneal dialysis (CAPD) which recovered with intraperitoneal 5-fluorocytosine alone is reported. This seems to be the first case of fungal peritonitis during CAPD without removing the catheter to be described in the literature.
Natural killer (NK) cell activity against two types of target cells was found to be low in patients with inactive alcoholic cirrhosis (AC). This defect was significantly more pronounced in AC patients with severe malnutrition than in those with mild or moderate malnutrition. This was not due to modifications of the kinetics of NK activity. The sera from AC patients had no inhibitory effect on the NK activity of normal subjects. Lymphocytes and macrophages from AC patients did not exert major suppressive effect on the NK activity of normal subjects. Interferon boosted the NK activity of cells from AC patients, but to a lesser degree than cells from normal controls. The findings show that a deficit of NK activity is clearly associated with inactive AC. This seems to be another consequence of AC on cellular immunity, and might be related to the protein calorie malnutrition often present in AC.
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This article reports a case of arteriocaliceal fistula following a kidney transplant biopsy. Hematuria and anuria were arrested by therapeutic embolic occlusion.
Moxalactam kinetics in renal failure were followed in eight patients undergoing chronic ambulatory peritoneal dialysis (CAPD) after a single 1-gm IV infusion. Elimination t 1/2 was 16.7 +/- 2.1 hr, with an apparent volume of distribution of 0.21 +/- 0.01 l/kg and plasma clearance of 10.6 +/- 2 ml/min. In 24 hr, 17.4 +/- 3.1% of the dose was present in the dialysis fluids, and 14.6 +/- 5.7% was excreted in the urine. Renal and peritoneal clearance values were thus 2.3 +/- 1.1 and 2.7 +/- 0.5 ml/min. Peritoneal concentrations were high (22.7 +/- 2.2 micrograms/ml). A recommended dosage schedule is proposed on the basis of moxalactam kinetics during CAPD.