Kidney transplantation. Modern trends in kidney transplantation.

Trends in renal transplantation stem from recognition of the virtues and drawbacks of this kind of treatment and from a better appreciation of the interrelationship between transplantation and dialysis

Liver Resection for Hepatic Adenoma

Between 1970 and 1978, eight hepatic adenomas were resected. Four of the eight patients took oral contraceptive pills before the hepatic adenoma was identified; one patient was male. Four patients had evidence of bleeding at the time of presentation. The original histologic diagnosis in the first five patients was malignant hepatoma. There has been no known recurrence of tumor and all patients are well. The use of oral contraceptives in these patients has been prohibited. Formal anatomic resection is recommended for hepatic adenoma when this procedure can be done without mortality or serious morbidity; however, in the future, less drastic treatments, such as occlusion of the hepatic arterial circulation to the tumor or discontinuation of oral contraceptives, may prove as effective as tumor resection. © 1979, American Medical Association. All rights reserved

An Optical Study of Two VY Sculptoris-Type Cataclysmic Binary Stars: V704 And and RX J2338+431

We report observations of the known cataclysmic variable star (CV) V704 And, and also confirm that the optical counterpart of the ROSAT Galactic Plane Survey source RX J2338+431 is a heretofore-neglected CV. Photometric and spectroscopic observations from MDM Observatory show both systems to be novalike variables that exhibit dips of 4-5 magnitudes from their mean brightnesses, establishing them as members of the VY~Scl subclass. From high-state emission-line radial velocities, we determine orbital periods of 0.151424(3) d (3.63 hr) for V704 And and 0.130400(1) d (3.13 hr) for RX J2338+431. In V704 And, we find that the H-alpha emission-line measures cluster into distinct regions on a plot of equivalent width versus full width at half-maximum, which evidently correspond to high, intermediate, and low photometric states. This allows us to assign spectra to photometric states when contemporaneous photometry is not available, an apparently novel method that may be useful in studies of other novalikes. Our low-state spectra of RX J2338+431 show features of an M-type secondary star, from which we estimate a distance of 890 +- 200 pc, in good agreement with the Gaia DR2 parallax.Comment: Accepted for Astronomical Journa

Gastrointestinal complications of hepatic transplantation

In this series of 150 orthotopic hepatic transplants, clinically significant gastrointestinal hemorrhage occurred in 34 patients (23%). Five patients (15%) survived this complication. Enteric perforations occurred in 20 patients following 198 biliary-enteric procedures. Only one patient survived. Enteric perforations unrelated to biliary procedures fared only slightly better with one survivor among eight perforations. These results clearly do not warrant complacency. Modifications advocated are an aggressive diagnostic approach and early reoperation with establishment of extensive peritoneal drainage where necessary

Thoracic duct drainage in organ transplantation: Will it permit better immunosuppression?

It is possible that thoracic-duct drainage, a major but neglected immunosuppressive adjunct, can have an important impact on organ transplantation. If thoracic-duct drainage is started at the time of transplantation, the practicality of its use in cadaveric cases is greatly enhanced. With kidney transplantation, the penalty of not having pretreatment for the first organ is compensanted by the automatic presence of pretreatment if rejection is not controlled and retransplantation becomes necessary. The advantage of adding thoracic-duct drainage to conventional immunosuppression may greatly enhance the expectations for the transplantation of extrarenal organs, such as the liver, pancreas, heart, and lung. There is evidence that pretreatment with thoracic-duct drainage of patients with cytotoxic antibodies may permit successful renal transplantation under these otherwise essentially hopeless conditions. Exploration of the neglected but potentially valuable tool of thoracic-duct drainage seems to the authors to be highly justified in other centers

Liver Transplantation for Budd-Chiari Syndrome

Orthotopic liver transplantation was accomplished in a 22-year-old woman dying of the Budd-Chiari syndrome. She is well and has normal liver function 16 months postoperatively. In view of the good early result, it will be appropriate to consider liver replacement for this disease in further well-selected cases. © 1976, American Medical Association. All rights reserved

Thoracic duct drainage before and after cadaveric kidney transplantation

Twenty-seven consecutive recipients of cadaveric kidneys, including five with pre-existing warm cytotoxic antibodies, were treated with thoracic duct drainage before and after transplantation. Fourteen patients who had lymph drainage for 26 to 58 days before transplantation had minor cytotoxic antibody responses after grafting, even if the antibodies had been present before therapy. Only one of the 14 recipients had any rejection during the follow-up periods of one to six months. There were two deaths. The 13 patients pretreated for 17 to 23 days exhibited stronger cytotoxic antibody responsiveness, and five of these recipients had significant rejections of which four were reversible. One of the latter 13 patients died. These clinical and immunologic studies have established the value and have defined the appropriate timing of preoperative thoracic duct drainage in kidney transplantation. They have also directed attention to the rationale and the probable value of using other immunosuppressive methods for preparatory host conditioning instead of beginning such therapy at the time of transplantation