Infectious Diseases Associated With Renal Homotransplantation: I. Incidence, Types, and Predisposing Factors

Infectious diseases occurred in 26 of 30 renal homotransplantation patients and contributed to eight of the 12 deaths in this series. There were 52 infections, 17 occurring before and 35 after transplantation. Infections were produced primarily by staphylococci, Pseudomonas species, and the enteric gram-negative bacilli. Staphylococcal infections occurred in 17 of 19 carriers of this organism and in only one of 11 noncarriers. Thirty-three of the 35 postoperative infections followed the intensification of immunosuppressive therapy for treatment of attempted homograft rejection. Granulocytopenia, steroid-induced diabetes, and hypogammaglobulinemia, from suppressive drug therapy, routinely preceded the onset of these complications. The infections, largely of endogenous origin, occurred when the host's defense mechanisms were depressed. © 1964, American Medical Association. All rights reserved

Clinical experience with organ transplantation

The authors have had an exceptional experience in the transplantations of organs in humans. This paper clearly indicates the current status in this area of medical experimentation. © 1965 Southern Medical Association

SPLENIC HOMOTRANSPLANTATION.

During the past 12 months, five clinical whole-organ splenic homotransplantations have been carried out with the objective of providing active immunologic tissue for the recipient patients. In one case with hypogammaglobulinemia, it was hoped that the transplanted tissue would alleviate a state of immunologic deficiency. In the other four, all of whom had terminal malignancies, the purpose was to superimpose a state of altered immunologic reactivity upon the host in the hope of thereby suppressing the inexorable growth of the neoplasms. As will be described, these procedures can now be judged in each instance to have been without benefit. Nevertheless, full documentation of the cases seems justified not only because of the many implications of transplantation of immunologically competent tissue, but also because of the potentially important observations made during the care of these patients. In addition, a full account will be presented of the supporting canine studies of splenic homotransplantation, inasmuch as many of the principles of clinical therapy and investigation derived from prior observations in the dog. The fact that it is possible to obtain viable splenic homografts in the dog for as long as two-thirds of a year without the production of runt disease or other harmful effects may have application in future research on bone marrow, other lymphoid, or hepatic homografts

Technique of Renal Homotransplantation: Experience With 42 Cases

Purely technical considerations play asignificant role in successful renal homotransplantation. Minimization of homograftischemia is critical. If blood supply to thecooled homograft can be restored within 40minutes, prompt urinary excretion can beexpected to follow. Longer periods of devascularizationresult in inconsistent earlyfunction. Even with ischemie intervals ofless than 40 minutes, there is an inverse correlation between the times necessary for vascular reconstruction and the quality of earlyrenal function.Additional important technical factors involve the site of placement of the homograft,provision for unkinked vascular channels,selection of a method of ureteroneocystostomywhich permits early removal of theurethral catheter, avoidance of all drains,and use of a one-stage operation incorporathemorrhage, diabetes mellitus, pancreatitis,thromboembolism, and neurologic disorders.The high incidence of such appears to be due to the high dose immunosuppressive therapy necessary to maintainviability of the homograft during the rejection crisis, to the terminal uremia which all patients are suffering at the timeof operation, and to specific elements of thetotal operative care such as splenectomy andinstrumentation of the pelvic veins. © 1964 IEEE All rights reserved

Transplantation Pneumonia

A clinically distinct pneumonitis occurred in six renal transplant recipients receiving azathioprine and prednisone immunosuppressive therapy. The patients ranged in age from 3 to 20 years. The onset was 42 to 102 days postoperatively, coinciding with decrease in prednisone dosage below approximately 1 mg per kilogram of body weight per day. Mild nonproductive cough, fever, and cynanosis were present. Chest x-rays demonstrated extensive hazy to nodular infiltrates usually involving both hila and lower lung fields. Cold agglutinins were present in five patients. Pulmonary function studies demonstrated an alveolar capillary block. The duration of illness was 12 to 34 days and was not influenced by antibiotic therapy. Autopsy of the single case in which death occurred revealed Pneumocystis carinii pneumonia and disseminated cytomegalic inclusion-body disease. © 1964, American Medical Association. All rights reserved