Steroid-resistant rejection: the effect of ATG on renal allograft survival.
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Biomedical subjects
Publications and source records attributed to G Sødal.
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Orthotopic liver transplantation was performed on a 23-year-old female with hereditary tyrosinaemia. The disorder was diagnosed at 7 years of age due to severe rickets, and the patient was treated with a diet restricted in phenylalanine and tyrosine. Nineteen months before the transplantation she had an acute episode of diffuse gastrointestinal bleeding due to portal hypertension. Three subsequent bleeding episodes with accompanying ascites and signs of encephalopathy were considered life-threatening. Nine months after the liver transplantation the patient is well, but serum transaminases are slightly elevated. Without dietary restrictions serum tyrosine and inorganic phosphate are normalized, no succinylacetone can be detected in serum, and urinary excretion of p-hydroxyphenyllactate and p-hydroxyphenylpyruvate is normal. Excretion of amino acids, glucose and beta 2-microglobulin decreased significantly after the transplantation but is still elevated. The succinylacetone concentration in urine is about 20% of the preoperative level. After an oral tyrosine load, succinylacetone excretion increased sevenfold but no deterioration of the renal tubular function was observed and no tyrosine metabolites were detectable in serum. The findings indicate that the defective tyrosine metabolism occurs in the kidneys, but does not produce tubular dysfunction. The residual tubular dysfunction of the patient is probably due to irreversible damage of the tubular epithelium.
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Reconstructive surgery for renal artery aneurysm requires adequate exposure and meticulous dissection. We report 9 patients with 17 aneurysms undergoing ex vivo aneurysmectomy. The reconstructions included vessel plasties, vein and arterial interponates, followed by autotransplantations to the iliac fossae. All kidneys functioned spontaneously, and all survived. Observation times of up to 7 years have now elapsed. Microsurgery and modern preservation techniques in the extracorporeal setting have extended the borders of renal artery surgery.
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Satisfactory computed tomograms were obtained in 57 of 64 patients with impaired function of renal allograft transplants. Surgical complications such as urinary obstruction or obstruction of arterial inflow, hemorrhage, urinoma, lymphocele, or abscess were found in 21 of 57 patients. Lymphocele was the most frequent. Although best demonstrated following intravenous contrast medium injection, 17 of 21 lesions could be diagnosed on precontrast scans. Noninvasive methods such as precontrast computed tomography (CT) or ultrasound (US) have replaced urography as the primary procedure in the diagnostic workup of these patients. If CT or US are inconclusive with regard to the size of the renal pelvis or if urinoma is suspected, high dose urography should be performed.
Four male outpatients, all on stable long-term hemodialysis, were by accident simultaneously exposed to hypotonic dialysate. Three of them developed increased serum amylase values and one died from the consequences of a fulminant pancreatitis, which had been verified by laparatomy.