Splenectomy and Thymectomy in Human Renal Homotransplantation

Five patients with terminal renal failure have been treated with renal homografts. Total body irradiation and cytotoxic drugs were used to prevent rejection. In addition, the thymus and spleen were surgically removed prior to the homotransplantation. Four of the 5 patients are alive with good renal function after 105 to 198 days. The role of thymectomy and splenectomy in conditioning patients for the receipt of homografts is highly speculative at present. However, the early success rate in this group of patients exceeds that generally attained with renal homografts, and appears to justify further clinical evaluation of this approach under carefully controlled experimental conditions. The data are insufficient to allow a recommendation for the general use of these adjuvant procedures. © 1963, SAGE Publications. All rights reserved

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

Pulmonary embolectomy in a patient with recent renal homotransplantation

A successful case of pulmonary embolectomy is described. Diagnosis was made when the patient developed cardiac arrest in the hospital ward. The embolus was removed with the aid of cardiopulmonary bypass. The principal clot was discovered in the right pulmonary artery, with an additional small fragment in the left main pulmonary artery. Several unique features of this case increased the problems of care during and after the embolectomy. The patient had received a renal homotransplant to the left iliac fossa from a patient of a different blood type 7 weeks earlier. The embolus was thought to have originated in the left leg distal to the renal vein anastomosis. Technical details of the cardiopulmonary bypass and the subsequent vena caval plication were planned with a view to protecting the function of the graft. The presence of the renal homograft may have contributed to the original formation of the peripheral thrombus. Finally, the postoperative care was complicated by the need to provide cytotoxic drug therapy for the continued protection of the homograft. This therapy, which weakens the immunologic response of the host, had to be modified when septic complications occurred during the postoperative period. Eventual recovery was possible with minimal loss of renal function. © 1964

The role of adrenocortical steroids in reversing established homograft rejection

Renal homotransplantation was performed in 8 dogs. Antirejection therapy with azathioprine (BW 57-322, Imuran) was given in doses of 2 to 7.5 mg. per kilogram per day. Evidence of rejection developed in all animals from 4 to 32 days following transplantation. When rejection had been established by at least 2 successive elevations of the BUN level, intramuscular injections of prednisolone (50 to 200 mg. per day) were added to the preexisting azathioprine therapy. Seven of the 8 animals had a favorable response evidenced by a falling BUN level, increased urine volumes, and decreasing proteinuria. Gastrointestinal bleeding was a serious complication in 6 of the 8 dogs. It was a direct or contributing cause of death in all 6. The rationale for the use of prednisolone in homotransplantation is discussed. From these experiments it would appear to be a valuable adjunct in reversing established rejection when added in large doses to preexisting antirejection therapy with azathioprine. Vigorous antacid therapy is indicated to prevent gastrointestinal ulceration and bleeding. © 1964