The fate of failed renal homografts retained after retransplantation

The fate of nonfunctioning or poorly functioning renal homografts which were left in situ at retransplantation was studied in 28 patients. In one recipient, lethal septicemia developed secondary to necrosis as well as infection of a retained intraabdominal graft. In three other patients, subsequent symptoms developed from retained extraperitoneal pelvic grafts, and these kidneys were removed without complication. It is suggested that grafts placed extraperitoneally can be left in place if retransplantation becomes necessary, provided that there is careful follow up study for signs of necrosis or infection. Removal of the kidney graft then may be performed electively at a later time, or this may never become necessary in a significant number of patients

Acute effect of prednisolone on renal handling of sodium.

The effect of prednisolone on renal handling of sodium (Na) was studied in rats under three experimental conditions: 1) hydropenia, 2) water diuresis, and 3) distal tubular blockade (DTB). Prednisolone, 0.25 mg/100 g per hr, was infused directly into left renal artery and urine was collected separately from each kidney. Predominantly unilateral increases in urine flow (V) and Na excretion were noticed in all experiments during prednisolone infusion. In the hydropenic rats the maximal increments on the infused side were, for V (mean ± SD), from 9.3 ± 1.5 to 21.4 ± 0.8 μl/min (P < 0.001); for C(Na)/C(In), from 0.28 ± 0.11 to 2.97 ± 0.71 % (P < 0.005); and for [Formula: see text] , from 2.93 ± 2.26 to 5.32 ± 1.92% (P < 0.05). In the rats with water diuresis, the maximal increases were, for V/C(In), from 5.87 ± 1.97 to 10.1 ± 6.0% (P < 0.005); for C(H(2)O)/C(In), from 4.09 ± 0.68 to 6.00 ± 0.44% (P < 0.0005); and for C(Na)/C(In), from 0.22 ± 0.07 to 0.70 ± 0.38% (P < 0.01). In DTB-rats the maximal increases were for V from 48.6 ± 9.0 to 72.7 ± 14.1 μl/min (P < 0.0005) and for C(Na)/C(In) from 9.42 ± 2.97 to 20.23 ± 7.34% (P < 0.005). In the contralateral kidney these changes were less pronounced. These observations suggest that prednisolone depresses directly Na reabsorption. The association of natriuresis with augmented [Formula: see text] and C(H(2)O)/C(In) during hydropenia and water diuresis, respectively, and the increases in V and C(Na)/C(In) during DTB, all are consistent with inhibition of Na reabsorption in the proximal tubule

Acute Alteration of Plasma Renin Activity by Large Doses of Intravenous Prednisolone

Large doses of intravenous glucocorticoids have been used in an attempt to reverse homograft rejection. The intravenous administration of 1 g prednisolone over 1 hr resulted in a significant acute reduction of plasma renin activity in 5 normal subjects tested and in 11 out of 15 patients bearing renal homografts. No definite explanation for failure to respond nor the mechanism of this prednisolone effect is readily at hand. An acute decrease in renin activity could be salutary for the chronically or acutely rejecting patient in that it could reduce vasopressor and salt-retaining effects. However, several of the non-responders had an increase in renin activity which could have been detrimental. © 1972, SAGE Publications. All rights reserved

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