Castro, L. A.

Illner, Wolf-Dieter

Land, Walter

Siebert, W.

Zöttlein, H.

English

Open Access LMU

Transplantation Proceedings An Official Publication of The Transplantation Society The Latin American Transplantation Society The Japan Society for Transplantation The European Society for Organ Transplantation The British Transplantation Society The Canadian Transplantation Society The Transplantation Society of Australia and New Zealand E D I T O R I A L S T A F F Felix T. Rapaport, M.D. , Editor-in-Chief, Stony Brook, N.Y. Jean Dausset, European Editor, Radoslav J. BachvarofT, Associate Editor, Paris. France Stony Brook, N. Y. David Anaise, Assistant Editor, Robert J. Corry, Assistant Editor (Clinical) Stony Brook, N.Y. Iowa City, Iowa Phillip R. Casson, Assistant Editor Wayne C. Waltzer, Assistant Editor (Abstracts) New York, N. Y. Stony Brook, N. Y. ADVISORY BOARD Fritz Bach, Minneapolis, Minn. Hans Balner, Rijswijk, Holland J. Richard Batchelor, England R. E. Billingham, Dallas, Tex. Leslie Brent, London, England Felix Cantarovich, Buenos Aires, Argentina RafTaello Cortesini, Rome, Italy Eli A. Friedman, Brooklyn, N.Y. Robert A. Good, Oklahoma City, Okla. Jean Hamburger, Paris, France Milan Hasek, Prague, Czechoslovakia George Klein, Stockholm, Sweden H. Sherwood Lawrence, New York, N.Y. H. M . Lee, Richmond, Va. Richard R. Lower, Richmond, Va. Robert McCluskey, Boston, Mass. Sir Peter Medawar, London, England John P. Merr i l l , Boston, Mass. ABSTRACTS Harold Atkins, Stony Brook, N.Y. Clyde F. Barker, Philadelphia, Pa. David Blumenstock, Cooperstown, N.Y. Lewis Burrows, New York, N.Y. C. B. Carpenter, Boston, Mass. Karel A. Dicke, Houston, Tex. Richard N . Fine, Los Angeles, Calif. Henry Godfrey, Valhalla, N.Y. Ronald D. Guttmann, Montreal, Canada Gail S. Habicht, Stony Brook, N. Y. Mark A. Hardy, New York. N.Y. George K. Kyriakides, Miami, Fla. H . M . Lee, Richmond, Va. Caliann T. Lum, Hershey, Pa. Robert E. McCabe, New York, N.Y. John C. McDonald, Shreveport, La. Gerardo Mendez-Picon, Richmond, Va. Frederick K. Merkel, Chicago, III. Felix Milgrom, Buffalo, N.Y. Anthony P. Monaco, Boston, Mass. John S. Najarian, Minneapolis, Minn. G. J. V. Nossal, Victoria, Australia Kendrick A. Porter, London, England Keith Reemtsma, New York, N. Y. Jorge Rodo, Buenos Aires, Argentina Paul S. Russell, Boston, Mass. Kenneth W. Sell, Bethesda, Md. Maurice Slapak, Portsmouth, England Thomas E. Starzl, Pittsburgh, Pa. Paul Terasaki, Los Angeles, Calif. Jules Traeger, Lyon, France Dick V. Van Bekkum, Rijswijk, Holland Jon J. Van Rood, Leiden, Netherlands David W. Weiss, Jerusalem, Israel Chester Zmijewski, Philadelphia, Pa. E D I T O R I A L BOARD Joshua Miller, Miami, Fla. Kamal Mit ta l , Bethesda, Md. Paul Nathan, Cincinnati, Ohio Israel Penn, Cincinnati, Ohio Herbert A. Perkins, San Francisco, Calif Robert R. Riggio, New York, N.Y. Jerry C. Rosenberg, Detroit, Mich. Leslie Rudolf, Charlottesville, Va. E. A. Santiago-Delpin, San Juan, Puerto Rico George W. Santos, Baltimore, Md. D. P. Singal, Ontario, Canada Sylvester SteriofT, Rochester, Minn. William T. Stubenbord, New York, N.Y. David E. R. Sutherland, Minneapolis, Minn. Judith Thomas, Greenville, N.C. Peter J. Tutschka, Baltimore, Md. Paul Weiden, Seattle, Wash. Horst Zincke, Rochester, Minn. A N N O U N C E M E N T Univarsitäts-Liio'lothek THE TRANSPLANTATION SOCIETY PAUL I . TERASAKI. President Department of Surgery University of California Medical School Los Angeles, California 90024 U.S.A. ISRAEL PENN, Secretary (Western) 3725 South Niagara Way Denver. Colorado 80237 U.S.A. SOCIETY OFFICERS PETER J . MORRIS President-Elect THOMAS J. GILL, i l l Vice-President GERHARD OPELZ Vies President OLGA JON ASSON Treasurer (Western) ARNOLD R SANDERSON Treasurer (Eastern) PETER R. BELL, Secretary (Eastern) Department of Surgery University of Leicester The General Hospital Leicester LE5 4PW, U.K. COUNCILLORS JEAN-FRANCOIS BACH CLYDE F. BARKER PRJSCILLA A . KINCAID-SMITH JAN KLEIN FELIX MILGROM JOHN S. NAJARIAN FELIX T. RAPAPORT ROBERT A . SELLS ARNE SVEJGAARD NICHOLAS L. TILNEY FRANK J. VEITH MARY L. WOOD The International Transplantation Society, the American Society of Transplant Surgeons, and the American Society of Transplant Physicians strongly condemn the recent scheme for commercial purchase of organs from living donors. This completely morally and ethically irresponsible proposal is rejected as abhorrent by a l l members of the Transplantation Societies. Removal of organs and transplantation of organs obtained commercially will not be handled by any member of the Transplantation Societies, and anyone doing so will be e/pelled. I M M E D I A T E PAST PRESIDENT HANS BALNER PAST PRESIDENTS D. BERNARD AMOS SIR PETER MEDAWAR JOHN M . CONVERSE JEAN HAMBURGER PAUL S. RUSSELL SIR MICHAEL WOODRUFF RUPERT E. BLLLDMGHAM LESLIE BRENT FELIX T. RAPAPORT Paul I . Terasaki, Ph.D. President, Transplantation Society Oscar Salvatierra, M.D. President, American Society of Transplant Surgeons Charles Carpenter American Society of Transplant Physicians TRANSPLANTATIO JAPONICA E D I T O R I A L S T A F F Yoji Iwasaki, M .D., Editor, Professor of Surgery, Insti-tute of Clinical Medicine, University of Tsukuba, Niihari-gun, Ibaraki-ken 305 Japan Tsunemasa Inou, M.D. , Editor, Professor, Department of Transplantation and Physiology, Institute of Medical Science, University of Tokyo M i k i Aizawa, M.D. , Editor, Professor of Pathology, Hokkaido University, School of Medicine Isamu Hashimoto, M.D. , Editor, Professor of Surgery, Kyoto Prefecture Medical College Azusa Ozaki, M.D. , Assistant Editor, Assistant Profes-sor of Surgery, Institute of Clinical Medicine, Univer-sity of Tsukuba ADVISORY BOARD Kokuo Nomoto, M.D. , Professor, Cancer Research Institute, Kyushu University Takato Yoshida, M.D., Professor, Department of Bacteriology, Hamamatsu Medical College Takehiko Sasazuki, M.D. , Professor. Department of Human Genetics, Tokyo Medical-Dental College Katsuaki Itakura, M.D. , Professor, Department of Pathology, Asahikawa Medical College Noboru Kashiwagi, M.D. , Professor, Department of Transplantation. Kitasato University School of Medicine Kiyoshi Takatsu, M.D. , Associate Professor. Cancer Institute, Osaka University School of Medicine Masaru Taniguchi, M.D. , Associate Professor, Department of Immunology, Chiba University School of Medicine Takeo Juji, M .D., Assistant Professor, Tokyo University School of Medicine Yasusuke Hirasawa, M.D., Associate Professor, Department of Orthopedics, Kyoto Pref Medical College Takao Sonoda, M.D., Professor, Department of Urology, Osaka University School of Medicine Kunzo Orita, M.D. , Professor, Department of Surgery, Okayama University School of Medicine Kimiyoshi Tsuji, M.D., Professor, Department of Surgery, Tokai University School of Medicine Yasuo Idetsuki, M.D. , Associate Professor. Department of Surgery, St. Marianna Medical College Osamu Ohotsubo, M.D. , Associate Professor, The Institute of Medical Science, Tokyo University Takenori Ochiai, M.D. , Assistant Professor, Department of Surgery, Chiba University School of Medicine Yoshio Taguchi, M.D. , Assistant Professor, Department of Surgery, Tohoku University School of Medicine Yukihiko Dohi, M.D. , Assistant Professor, Department of Surgery, Hiroshima University School of Medicine Hiroshi Takagi, M.D. , Aichi Cancer Center Hospital Hiroshi Amemiya, M.D. , National Cardiovascular Center, Research Institute Mitsuo Mito, M D . , Professor, Department of Surgery, Asahikawa Medical College Yoshio Kondo, M.D. , Professor, Department of Surgery, Tokyo University Branch Hospital Kazuo Ohota, M.D. , Professor, Kidney Center, Tokyo Women's Medical College Hisanori Uchida, M.D. , Associate Professor, Department of Surgery, Kitasato University School of Medicine Masumi Nozawa, M.D. , Associate Professor, Department of Surgery, Osaka Medical College Kazumasa Yamada, M.D. , Associate Professor, Department of Internal Medicine, Nagoya University School of Medicine Shigeyoshi Fujimoto, M.D. , Professor, Department of Immunology, Kochi Medical College First International Congress on Organ Procurement Organizing Committee G. Kootstra, M .D., President, Maastricht, The Netherlands J. A. van der Vliet, M .D. , Secretary, Maastricht, The Netherlands J. M . Greept, M .D., Treasurer, Maastricht, The Netherlands W. A. Buurman, Ph.D., Maastricht, The Netherlands J. P. van Hooff, M.D. , Maastricht, The Netherlands B. Cohen, M.Ec., Leiden, The Netherlands P. J. G. Jörning, M.D. , Maastricht, The Netherlands E. L. M . Hardy, Pharm.D., Maastricht, The Netherlands R. A . P. Koene, M .D., Nijmegen, The Netherlands J. P. A . M. Vroemen, M.D. , Maastricht, The Netherlands Scientific Committee B. Husberg, M . D . , Chairman, Malmö, Sweden J. A. van der Vliet, M . D . , Co-Chairman, Maastricht, The Netherlands G. Kootstra, M.D. , Secretary, Maastricht, The Netherlands F. O. Beizer, M.D. , Madison, USA R. A. F. Krom, M.D. , Groningen, The Netherlands J. M . Dubernard, M.D. , Lyon, France W. Land, M.D. , Munich, FRG N . A. Halasz, M.D. , San Diego, USA T. Lerut, M.D. , Leuven, Belgium P. M . McMaster, M.D. , Birmingham, UK International Advisory Board G. Abouna, Safat, Kuwait G. P. J. Alexandre, Brussels, Belgium H. Balner, Brussels, Belgium C. Barnard, Cape Town, South Africa F. O. Beizer, Madison, USA C. Cabrol, Paris, France R. Y. Calne, Cambridge. UK J. Corman, Montreal. Canada J. M . Dubernard, Lyon. France A. Flatmark, Oslo. Norway J. M . Greep, Maastricht, The Netherlands F. M . Guttman, Montreal, Canada N . A. Halasz, San Diego, USA B. Husberg, Malmö, Sweden H. Kreis, Paris, France R. A. F. Krom, Groningen, The Netherlands W. Land, Munich, FRG F. Largiader, Zurich. Switzerland T. Lerut, Leuven, Belgium R. Margreiter, Innsbruck, Austria V. C. Marshall, Melbourne, Australia P. M . McMaster, Birmingham, UK G. May, Berlin, GDR H . Oesterwitz, Berlin, GDR D. E. Pegg, Cambridge, UK R. Pichlmayr, Hannover, FRG J.J. van Rood, Leiden, The Netherlands M . Slapak, Portsmouth, UK E. K. Spees, Baltimore, USA T. E. Starzl, Pittsburgh, USA F. Stuart, Chicago, USA D. E. R. Sutherland, Minneapolis, USA AUTHOR INDEX Abeyounis, C. J., 489 Alexander, P., 486 Anderson, G. R., 449 Andrieu, J. M . , 455 BachvarorT, R. J., 361 Bagley, C , 562 Baron, S., 516 Bertram, J. S., 379 Black, J. J., 406 Bonsib, S. M . , 555 Buckner, C. D., 562 Buonaguro, F., 386 Burgess, G., 507 Bursuker, 1., 463 Caterson, R. J., 559 Chang, C.-C., 363 Chu, T. M . , 481 Clift, R. A., 562 Cook, J. L.,441 Corry, R. J., 555 Dekaban, G. A. , 428 Dunlop, N . M . , 428 Eccles, S. A., 486 Ehrke, M . J., 499 Elkind, M . M . , 386 Ercolani, L., 555 Farkas, B. K., 449 Feldman, L. T., 438 Fidler, I . J., 370 Fischinger, P. J., 428 Fleischmann, Jr., W. R., 516 Forstrom, J. W., 470 Fuji, H., 460 Furber, J., 559 Gony, J., 455 Graham, S., 392 Griesemer, R. A. , 412 Guttmann, R. D., 495 Han, A., 386 Hauser, J., 441 Hellström, 1., 470 Hellström, K. E., 470 Helm, F., 507 Herberman, R. B., 476 H i l l , C. K.,386 Holtermann, O. A. , 507 Hors, J., 455 Houghton, A. N . , 351 Huberman, E., 349 Imperiale, M . J., 438 Johnson, E., 483 Kao, H . T . , 438 Killian, C.S.,481 Kim, LL, 373 Klein, E., 507 Klein, L. E., 507 Kumpel, G. R., 516 Kripke, M . U 474 Kuriyama, M . , 481 Leister, K . J . , 381 Levine, A. S., 441 Lewis, Jr., A. M . , 441 LoBue, J., 341 LoBue, P. A., 341 Lynch, R. G., 458 Mahony, J. F., 559 Manson, L. A. , 524 McCarthy, W., 559 Meakins, J. L. , 495 Mihich, E.,499 Milburn, G. L. , 458 Milgrom, F., 489 Milgrom, H. , 507 Miller, F., 361 Murphy, G. P., 337, 481 Murray, J., 559 Nelson, K., 470 Nepom, G. T., 470 Nevins, J. R., 438 Nghiem, D. D., 555 Nicolson,G. L. , 355 North, R. J., 463 O'Connor, T. E., 537 Pagano, J.S., 419 Papsidero, L . D., 481 Patch, C .T . , 441 Penn, I . , 492 Rapaport, F. T., 361 Rittenhouse, K. W.,489 Robey, W. G., 428 Rosner, D., 507 Sabovä, L. , 435 Sandberg, A . A. , 366 Schulak, J. A. , 555 Sheil, A . G . R., 559 Sivak, A., 403 Smida, J., 435 Smidovä, V„ 435 Steck, P. A. , 355 Stevens, L. C , 502 Stewart, P., 562 Stoll, H . L. , 507 Talmadge, J. E., 370 Thomas, E. D., 562 Tomei, L . D., 381 Trosko, J. E., 363 Tyring, S. K., 516 Urbach, F., 390 Wang, M.C . ,481 Weiss, D. W., 528, 545 Wenner,C. E., 381 Wilhelm, S. A. , 489 5 6 4 Transplantation Proceedings, Vol . XVI , No. 2 (April), 1984 Cyclosporine A in Kidney-Transplanted Patients Without In i t ia l Diuresis W. Siebert, W.-D. Iiiner, H. Zöttlein, L. A. Castro, and W. Land Basic Immunosuppressive Treatment CY C L O S P O R I N E A ( C s A ) as a new immunosuppressive drug has improved the results of organ transplantation remark-ably. Its main side effect is nephrotoxicity. Therefore, the administration of C s A was restricted to recipients with primary function-ing grafts within the European Multicenter study.1 In contrast to that study, we started to treat all our patients with C s A , regardless of whether they had immediate graft function or not. Preliminary results of that pilot study have already been published elsewhere. 2 Using that policy of C s A treatment it was of interest to find out the alternating effects between cold ischemia time, incidence of A T N , and graft survival rate, as well as long-term graft function and hepatotoxic side effects. The following questions have been investi-gated: (1) Docs a long cold ischemia time lead to a higher incidence of primarily non-functioning allografts in CsA-treated patients, compared with conventionally treated patients? (2) Is there any influence of nonfunction-ing kidneys on the graft survival under C s A therapy? (3) Is the posttransplantation function of renal cadaveric allografts under C s A therapy poorer in patients having received nonfunctioning kidneys? (4) Is there a hepatotoxic side effect of therapeutic relevance? MATERIALS AND METHODS One-hundred forly-six cadaveric renal transplantations were performed at our center between March 1982 and March 1983 ( I . transplant: 116, 2. transplants: 20, 3 transplants: 4, kidney and pancreas transplants: 6). A l l patients received at least 3 blood transfusions before transplantation. CsA: I 7 mg/kg body weight (b.w.) — 8-6 mg/kg b.w. MP:8 mg/kg daily from the beginning. Antirejection Therapy ( I ) rejection episode: 3 x 500 mg methylprednisolone (MP) . (2) / (3) rejection episode: A L G + 120 mg MP over a period of 7 days. Historical Controls Historical controls were 277 patients treated with steroids and azathioprinc (July 1976 February 1982). Definition of the incidence of primarily nonfunctioning kidneys (ATN-kidneys): renal transplantation is a recip-ient requiring at least one postoperative hemodialysis. Preservation of all Renal Transplants Preservation of all renal transplants was accomplished by using Euro-Collins' solution, for perfusion and after ice storage. A T N - i n c i d e n c e r e l a t e d to c o l d i s c h e m i a t i m e Fig. 1. ATN- inc idence (-=rate of primarily non-functioning kidneys) related to cold ischemia t ime (CIT) . C y A . cyclosporine. From the Transplantation Centre Munich, Dept. of Surgery, Klinikum Großhadern, University of Munich, W. Germany. Reprint requests should be addressed to Prof. Dr. W. Land, Transplantation Centre, Klinikum Großhadern, Marchioninisir. 15, 8000 München 70 j W. Germany. © 1984 by Grune & St ration. Inc. 0041 1345/84/1601 -0085$01.00/0 Transplantation Proceedings, Vol. XVI , No. 1 (February), 1 9 8 4 2 8 5 2 8 6 SIEBERT ET A L . o. > 20. Basic i.s. therapy * CyA plus Steroids C8mg/dally) w 0 ' i ' 4 ' 6 1 A VoMon 12 (March 83) Fig. 2. Graft survival rate in correlat ion to primarily functioning (nin-ATN)-nonfunctioning (ATN) kidneys. C y A , cyclosporine. RESULTS AND CONCLUSION With regard to our experience, there is a correlation between length of cold ischemia time and the incidence of nonfunctioning ATN-kidneys, regardless of whether the recipients were treated with C s A or conven-tionally ( F i g . l ) . The number of ATN-kidneys increased from 29% in the group with the shortest cold ischemia time up to 81.8% for kidneys with an ice storage time over 36 hr. It has to be discussed that the high incidence (61.6%) of primarily nonfunctioning kidneys may be ascribed to the "Munich Moder' of organ harvesting, since about 70% of all donor nephrectomies are performed in smaller com-munity hospitals. In those hospitals the ade-quate handling of donors may not be sufficient (especially in intensive care). The results of cadaveric renal transplanta-tion under C s A therapy are significantly Table 1. Graft Survival for A T N and non-ATN (March 1982 to March 1983) Lost Functioning Total ATN 24 2 6 . 7 % 66 7 3 . 3 % 9 0 6 1 . 6 % Non-ATN 6 1 0 . 7 % 5 0 8 9 . 3 % 56 3 8 . 4 % Total 30 2 0 . 5 % 1 16 7 9 . 5 % 146 1 0 0 % Bis: CsA + steroids. Table 2. Graft Function in C s A - T r e a t e d Recipients W i t h / W i t h o u t A T N Kidneys Creatinine Creatinine Creatinine (mg /100 ml) ( m g / 1 0 0 ml) (mg/100 ml) 1 month 3 months 6 months ATN 3 .10 2 .39 2 .35 V = 3.43 V = 1.28 V = 0 .78 SDEV 1.85 SDEV = 1.13 SDEV = 0 .88 n = 55 n - 5 2 n = 25 Non-ATN 2 .12 2 .17 1.99 V - 0 . 8 0 V = 1.33 V = 1.08 SDEV = 0 .89 SDEV = 1.15 SDEV = 1.04 n = 35 n = 35 n = 2 4 V, variance. SDEV, standard deviation. N, number o f patients. Only patients w i th functioning grafts were observed at least 6 months after transplantation. poorer in patients having received A T N -kidney transplants (15.2% difference in the graft survival rate; p = 0.04) (Fig. 2 and Table 1). The graft survival probability for 12 months is only 66.8% for ATN-kidneys, but 82% for non-ATN-kidneys. Further controls after 18 or 24 months will show whether the preliminary results remain the same. A short cold ischemia time in cadaveric renal transplants is certainly of great impor-tance (fewer ATN-kidneys, better results), especially under C s A therapy (nephrotoxic side effects). As regards the late graft function (6 months pop.) under C s A treatment, there seems to be no statistical difference between Table 3. Hepatotoxic Side Effect of C s A in Patients W i t h / W i t h o u t Preexist ing Liver Disease Bilirubin Bilirubin ( m g / 1 0 0 m l ) (fig/100 ml) 1 Month 3 Months Preex. hepatopathy 1.02 0 .98 V = 0 .19 V = 0.45 SDEV = 0 . 4 4 SDEV 0.67 n - 17 n = 15 Wi thout 1.14 0 .92 preex. hepatopathy V = 0 .05 V 0.19 SDEV = 0 .23 SDEV = 0.44 n = 6 2 n - 56 V, variance. SDEV, standard deviation, n, number of patients. CSA AND ATN KIDNEYS 2 8 7 nonfunctioning (ATN)-k idney transplants and non-ATN-kidneys (Table 2). If the organs are not rejected before 6 months, the creatinine values are nearly the same in A T N and non-ATN-kidneys, but 26.7% of the ATN-kidneys are rejected within 6 months posttransplant. Relevant hepatotoxic side effects could not be seen in our patients neither in the group with, nor in the group without preexisting hepatopathy (Table 3). Summing up, there remains the relevance of a short cold ischemia time (under 30 hr) for a lessened incidence of primarily nonfunction-ing kidneys and a better graft survival. REFERENCES 1. Sandoz Ltd. and participating centres; Lancet 2:57, 2. Land W, Castro LA, Miner W D , et al: Fortschr Med 1982 41:1912,1982 

Ltd. and participating centres;

Cyclosporine A in kidney-transplanted patients without initial diuresis.

Universität München: Elektronischen Publikationen

Transplantation Proceedings 
An Official Publication of 
The Transplantation Society The Latin American Transplantation Society 
The Japan Society for Transplantation The European Society for Organ Transplantation 
The British Transplantation Society The Canadian Transplantation Society 
The Transplantation Society of Australia and New Zealand 
E D I T O R I A L S T A F F 
Felix T. Rapaport, M.D. , Editor-in-Chief, Stony Brook, N.Y. 
Jean Dausset, European Editor, Radoslav J. BachvarofT, Associate Editor, 
Paris. France Stony Brook, N. Y. 
David Anaise, Assistant Editor, Robert J. Corry, Assistant Editor (Clinical) 
Stony Brook, N.Y. Iowa City, Iowa 
Phillip R. Casson, Assistant Editor Wayne C. Waltzer, Assistant Editor (Abstracts) 
New York, N. Y. Stony Brook, N. Y. 
ADVISORY BOARD 
Fritz Bach, Minneapolis, Minn. 
Hans Balner, Rijswijk, Holland 
J. Richard Batchelor, England 
R. E. Billingham, Dallas, Tex. 
Leslie Brent, London, England 
Felix Cantarovich, Buenos Aires, Argentina 
RafTaello Cortesini, Rome, Italy 
Eli A. Friedman, Brooklyn, N.Y. 
Robert A. Good, Oklahoma City, Okla. 
Jean Hamburger, Paris, France 
Milan Hasek, Prague, Czechoslovakia 
George Klein, Stockholm, Sweden 
H. Sherwood Lawrence, New York, N.Y. 
H. M . Lee, Richmond, Va. 
Richard R. Lower, Richmond, Va. 
Robert McCluskey, Boston, Mass. 
Sir Peter Medawar, London, England 
John P. Merr i l l , Boston, Mass. 
ABSTRACTS 
Harold Atkins, Stony Brook, N.Y. 
Clyde F. Barker, Philadelphia, Pa. 
David Blumenstock, Cooperstown, N.Y. 
Lewis Burrows, New York, N.Y. 
C. B. Carpenter, Boston, Mass. 
Karel A. Dicke, Houston, Tex. 
Richard N . Fine, Los Angeles, Calif. 
Henry Godfrey, Valhalla, N.Y. 
Ronald D. Guttmann, Montreal, Canada 
Gail S. Habicht, Stony Brook, N. Y. 
Mark A. Hardy, New York. N.Y. 
George K. Kyriakides, Miami, Fla. 
H . M . Lee, Richmond, Va. 
Caliann T. Lum, Hershey, Pa. 
Robert E. McCabe, New York, N.Y. 
John C. McDonald, Shreveport, La. 
Gerardo Mendez-Picon, Richmond, Va. 
Frederick K. Merkel, Chicago, III. 
Felix Milgrom, Buffalo, N.Y. 
Anthony P. Monaco, Boston, Mass. 
John S. Najarian, Minneapolis, Minn. 
G. J. V. Nossal, Victoria, Australia 
Kendrick A. Porter, London, England 
Keith Reemtsma, New York, N. Y. 
Jorge Rodo, Buenos Aires, Argentina 
Paul S. Russell, Boston, Mass. 
Kenneth W. Sell, Bethesda, Md. 
Maurice Slapak, Portsmouth, England 
Thomas E. Starzl, Pittsburgh, Pa. 
Paul Terasaki, Los Angeles, Calif. 
Jules Traeger, Lyon, France 
Dick V. Van Bekkum, Rijswijk, Holland 
Jon J. Van Rood, Leiden, Netherlands 
David W. Weiss, Jerusalem, Israel 
Chester Zmijewski, Philadelphia, Pa. 
E D I T O R I A L BOARD 
Joshua Miller, Miami, Fla. 
Kamal Mit ta l , Bethesda, Md. 
Paul Nathan, Cincinnati, Ohio 
Israel Penn, Cincinnati, Ohio 
Herbert A. Perkins, San Francisco, Calif 
Robert R. Riggio, New York, N.Y. 
Jerry C. Rosenberg, Detroit, Mich. 
Leslie Rudolf, Charlottesville, Va. 
E. A. Santiago-Delpin, San Juan, Puerto Rico 
George W. Santos, Baltimore, Md. 
D. P. Singal, Ontario, Canada 
Sylvester SteriofT, Rochester, Minn. 
William T. Stubenbord, New York, N.Y. 
David E. R. Sutherland, Minneapolis, Minn. 
Judith Thomas, Greenville, N.C. 
Peter J. Tutschka, Baltimore, Md. 
Paul Weiden, Seattle, Wash. 
Horst Zincke, Rochester, Minn. 
A N N O U N C E M E N T 
Univarsitäts-
Liio'lothek 
THE TRANSPLANTATION SOCIETY 
PAUL I . TERASAKI. President 
Department of Surgery 
University of California Medical School 
Los Angeles, California 90024 
U.S.A. 
ISRAEL PENN, Secretary (Western) 
3725 South Niagara Way 
Denver. Colorado 80237 
U.S.A. 
SOCIETY OFFICERS 
PETER J . MORRIS 
President-Elect 
THOMAS J. GILL, i l l 
Vice-President 
GERHARD OPELZ 
Vies President 
OLGA JON ASSON 
Treasurer (Western) 
ARNOLD R SANDERSON 
Treasurer (Eastern) 
PETER R. BELL, Secretary (Eastern) 
Department of Surgery 
University of Leicester 
The General Hospital 
Leicester LE5 4PW, U.K. 
COUNCILLORS 
JEAN-FRANCOIS BACH 
CLYDE F. BARKER 
PRJSCILLA A . KINCAID-SMITH 
JAN KLEIN 
FELIX MILGROM 
JOHN S. NAJARIAN 
FELIX T. RAPAPORT 
ROBERT A . SELLS 
ARNE SVEJGAARD 
NICHOLAS L. TILNEY 
FRANK J. VEITH 
MARY L. WOOD 
The International Transplantation Society, the American 
Society of Transplant Surgeons, and the American Society of 
Transplant Physicians strongly condemn the recent scheme for 
commercial purchase of organs from living donors. This completely 
morally and ethically irresponsible proposal is rejected as 
abhorrent by a l l members of the Transplantation Societies. 
Removal of organs and transplantation of organs obtained commercially 
will not be handled by any member of the Transplantation Societies, 
and anyone doing so will be e/pelled. 
I M M E D I A T E PAST 
PRESIDENT 
HANS BALNER 
PAST PRESIDENTS 
D. BERNARD AMOS 
SIR PETER MEDAWAR 
JOHN M . CONVERSE 
JEAN HAMBURGER 
PAUL S. RUSSELL 
SIR MICHAEL WOODRUFF 
RUPERT E. BLLLDMGHAM 
LESLIE BRENT 
FELIX T. RAPAPORT 
Paul I . Terasaki, Ph.D. 
President, Transplantation Society 
Oscar Salvatierra, M.D. 
President, American Society 
of Transplant Surgeons 
Charles Carpenter 
American Society of Transplant Physicians 
TRANSPLANTATIO JAPONICA 
E D I T O R I A L S T A F F 
Yoji Iwasaki, M .D., Editor, Professor of Surgery, Insti-
tute of Clinical Medicine, University of Tsukuba, 
Niihari-gun, Ibaraki-ken 305 Japan 
Tsunemasa Inou, M.D. , Editor, Professor, Department of 
Transplantation and Physiology, Institute of Medical 
Science, University of Tokyo 
M i k i Aizawa, M.D. , Editor, Professor of Pathology, 
Hokkaido University, School of Medicine 
Isamu Hashimoto, M.D. , Editor, Professor of Surgery, 
Kyoto Prefecture Medical College 
Azusa Ozaki, M.D. , Assistant Editor, Assistant Profes-
sor of Surgery, Institute of Clinical Medicine, Univer-
sity of Tsukuba 
ADVISORY BOARD 
Kokuo Nomoto, M.D. , Professor, Cancer Research 
Institute, Kyushu University 
Takato Yoshida, M.D., Professor, Department of 
Bacteriology, Hamamatsu Medical College 
Takehiko Sasazuki, M.D. , Professor. Department of 
Human Genetics, Tokyo Medical-Dental College 
Katsuaki Itakura, M.D. , Professor, Department of 
Pathology, Asahikawa Medical College 
Noboru Kashiwagi, M.D. , Professor, Department of 
Transplantation. Kitasato University School of 
Medicine 
Kiyoshi Takatsu, M.D. , Associate Professor. Cancer 
Institute, Osaka University School of Medicine 
Masaru Taniguchi, M.D. , Associate Professor, 
Department of Immunology, Chiba University 
School of Medicine 
Takeo Juji, M .D., Assistant Professor, Tokyo University 
School of Medicine 
Yasusuke Hirasawa, M.D., Associate Professor, 
Department of Orthopedics, Kyoto Pref Medical 
College 
Takao Sonoda, M.D., Professor, Department of 
Urology, Osaka University School of Medicine 
Kunzo Orita, M.D. , Professor, Department of Surgery, 
Okayama University School of Medicine 
Kimiyoshi Tsuji, M.D., Professor, Department of 
Surgery, Tokai University School of Medicine 
Yasuo Idetsuki, M.D. , Associate Professor. Department 
of Surgery, St. Marianna Medical College 
Osamu Ohotsubo, M.D. , Associate Professor, The 
Institute of Medical Science, Tokyo University 
Takenori Ochiai, M.D. , Assistant Professor, 
Department of Surgery, Chiba University School of 
Medicine 
Yoshio Taguchi, M.D. , Assistant Professor, Department 
of Surgery, Tohoku University School of Medicine 
Yukihiko Dohi, M.D. , Assistant Professor, Department 
of Surgery, Hiroshima University School of 
Medicine 
Hiroshi Takagi, M.D. , Aichi Cancer Center Hospital 
Hiroshi Amemiya, M.D. , National Cardiovascular 
Center, Research Institute 
Mitsuo Mito, M D . , Professor, Department of Surgery, 
Asahikawa Medical College 
Yoshio Kondo, M.D. , Professor, Department of Surgery, 
Tokyo University Branch Hospital 
Kazuo Ohota, M.D. , Professor, Kidney Center, Tokyo 
Women's Medical College 
Hisanori Uchida, M.D. , Associate Professor, 
Department of Surgery, Kitasato University School 
of Medicine 
Masumi Nozawa, M.D. , Associate Professor, 
Department of Surgery, Osaka Medical College 
Kazumasa Yamada, M.D. , Associate Professor, 
Department of Internal Medicine, Nagoya University 
School of Medicine 
Shigeyoshi Fujimoto, M.D. , Professor, Department of 
Immunology, Kochi Medical College 
First International Congress 
on 
Organ Procurement 
Organizing Committee 
G. Kootstra, M .D., President, Maastricht, The Netherlands 
J. A. van der Vliet, M .D. , Secretary, Maastricht, The Netherlands 
J. M . Greept, M .D., Treasurer, Maastricht, The Netherlands 
W. A. Buurman, Ph.D., Maastricht, The Netherlands J. P. van Hooff, M.D. , Maastricht, The Netherlands 
B. Cohen, M.Ec., Leiden, The Netherlands P. J. G. Jörning, M.D. , Maastricht, The Netherlands 
E. L. M . Hardy, Pharm.D., Maastricht, The Netherlands R. A . P. Koene, M .D., Nijmegen, The Netherlands 
J. P. A . M. Vroemen, M.D. , Maastricht, The Netherlands 
Scientific Committee 
B. Husberg, M . D . , Chairman, Malmö, Sweden 
J. A. van der Vliet, M . D . , Co-Chairman, Maastricht, The Netherlands 
G. Kootstra, M.D. , Secretary, Maastricht, The Netherlands 
F. O. Beizer, M.D. , Madison, USA R. A. F. Krom, M.D. , Groningen, The Netherlands 
J. M . Dubernard, M.D. , Lyon, France W. Land, M.D. , Munich, FRG 
N . A. Halasz, M.D. , San Diego, USA T. Lerut, M.D. , Leuven, Belgium 
P. M . McMaster, M.D. , Birmingham, UK 
International Advisory Board 
G. Abouna, Safat, Kuwait 
G. P. J. Alexandre, Brussels, Belgium 
H. Balner, Brussels, Belgium 
C. Barnard, Cape Town, South Africa 
F. O. Beizer, Madison, USA 
C. Cabrol, Paris, France 
R. Y. Calne, Cambridge. UK 
J. Corman, Montreal. Canada 
J. M . Dubernard, Lyon. France 
A. Flatmark, Oslo. Norway 
J. M . Greep, Maastricht, The Netherlands 
F. M . Guttman, Montreal, Canada 
N . A. Halasz, San Diego, USA 
B. Husberg, Malmö, Sweden 
H. Kreis, Paris, France 
R. A. F. Krom, Groningen, The Netherlands 
W. Land, Munich, FRG 
F. Largiader, Zurich. Switzerland 
T. Lerut, Leuven, Belgium 
R. Margreiter, Innsbruck, Austria 
V. C. Marshall, Melbourne, Australia 
P. M . McMaster, Birmingham, UK 
G. May, Berlin, GDR 
H . Oesterwitz, Berlin, GDR 
D. E. Pegg, Cambridge, UK 
R. Pichlmayr, Hannover, FRG 
J.J. van Rood, Leiden, The Netherlands 
M . Slapak, Portsmouth, UK 
E. K. Spees, Baltimore, USA 
T. E. Starzl, Pittsburgh, USA 
F. Stuart, Chicago, USA 
D. E. R. Sutherland, Minneapolis, USA 
AUTHOR INDEX 
Abeyounis, C. J., 489 
Alexander, P., 486 
Anderson, G. R., 449 
Andrieu, J. M . , 455 
BachvarorT, R. J., 361 
Bagley, C , 562 
Baron, S., 516 
Bertram, J. S., 379 
Black, J. J., 406 
Bonsib, S. M . , 555 
Buckner, C. D., 562 
Buonaguro, F., 386 
Burgess, G., 507 
Bursuker, 1., 463 
Caterson, R. J., 559 
Chang, C.-C., 363 
Chu, T. M . , 481 
Clift, R. A., 562 
Cook, J. L.,441 
Corry, R. J., 555 
Dekaban, G. A. , 428 
Dunlop, N . M . , 428 
Eccles, S. A., 486 
Ehrke, M . J., 499 
Elkind, M . M . , 386 
Ercolani, L., 555 
Farkas, B. K., 449 
Feldman, L. T., 438 
Fidler, I . J., 370 
Fischinger, P. J., 428 
Fleischmann, Jr., W. R., 516 
Forstrom, J. W., 470 
Fuji, H., 460 
Furber, J., 559 
Gony, J., 455 
Graham, S., 392 
Griesemer, R. A. , 412 
Guttmann, R. D., 495 
Han, A., 386 
Hauser, J., 441 
Hellström, 1., 470 
Hellström, K. E., 470 
Helm, F., 507 
Herberman, R. B., 476 
H i l l , C. K.,386 
Holtermann, O. A. , 507 
Hors, J., 455 
Houghton, A. N . , 351 
Huberman, E., 349 
Imperiale, M . J., 438 
Johnson, E., 483 
Kao, H . T . , 438 
Killian, C.S.,481 
Kim, LL, 373 
Klein, E., 507 
Klein, L. E., 507 
Kumpel, G. R., 516 
Kripke, M . U 474 
Kuriyama, M . , 481 
Leister, K . J . , 381 
Levine, A. S., 441 
Lewis, Jr., A. M . , 441 
LoBue, J., 341 
LoBue, P. A., 341 
Lynch, R. G., 458 
Mahony, J. F., 559 
Manson, L. A. , 524 
McCarthy, W., 559 
Meakins, J. L. , 495 
Mihich, E.,499 
Milburn, G. L. , 458 
Milgrom, F., 489 
Milgrom, H. , 507 
Miller, F., 361 
Murphy, G. P., 337, 481 
Murray, J., 559 
Nelson, K., 470 
Nepom, G. T., 470 
Nevins, J. R., 438 
Nghiem, D. D., 555 
Nicolson,G. L. , 355 
North, R. J., 463 
O'Connor, T. E., 537 
Pagano, J.S., 419 
Papsidero, L . D., 481 
Patch, C .T . , 441 
Penn, I . , 492 
Rapaport, F. T., 361 
Rittenhouse, K. W.,489 
Robey, W. G., 428 
Rosner, D., 507 
Sabovä, L. , 435 
Sandberg, A . A. , 366 
Schulak, J. A. , 555 
Sheil, A . G . R., 559 
Sivak, A., 403 
Smida, J., 435 
Smidovä, V„ 435 
Steck, P. A. , 355 
Stevens, L. C , 502 
Stewart, P., 562 
Stoll, H . L. , 507 
Talmadge, J. E., 370 
Thomas, E. D., 562 
Tomei, L . D., 381 
Trosko, J. E., 363 
Tyring, S. K., 516 
Urbach, F., 390 
Wang, M.C . ,481 
Weiss, D. W., 528, 545 
Wenner,C. E., 381 
Wilhelm, S. A. , 489 
5 6 4 Transplantation Proceedings, Vol . XVI , No. 2 (April), 1984 
Cyclosporine A in Kidney-Transplanted Patients 
Without In i t ia l Diuresis 
W. Siebert, W.-D. Iiiner, H. Zöttlein, L. A. Castro, and W. Land 
Basic Immunosuppressive Treatment CY C L O S P O R I N E A ( C s A ) as a new immunosuppressive drug has improved 
the results of organ transplantation remark-
ably. Its main side effect is nephrotoxicity. 
Therefore, the administration of C s A was 
restricted to recipients with primary function-
ing grafts within the European Multicenter 
study.1 
In contrast to that study, we started to treat 
all our patients with C s A , regardless of 
whether they had immediate graft function or 
not. Preliminary results of that pilot study 
have already been published elsewhere. 2 
Using that policy of C s A treatment it was of 
interest to find out the alternating effects 
between cold ischemia time, incidence of 
A T N , and graft survival rate, as well as 
long-term graft function and hepatotoxic side 
effects. 
The following questions have been investi-
gated: 
(1) Docs a long cold ischemia time lead to 
a higher incidence of primarily non-
functioning allografts in CsA-treated 
patients, compared with conventionally 
treated patients? 
(2) Is there any influence of nonfunction-
ing kidneys on the graft survival under 
C s A therapy? 
(3) Is the posttransplantation function of 
renal cadaveric allografts under C s A 
therapy poorer in patients having 
received nonfunctioning kidneys? 
(4) Is there a hepatotoxic side effect of 
therapeutic relevance? 
MATERIALS AND METHODS 
One-hundred forly-six cadaveric renal transplantations 
were performed at our center between March 1982 and 
March 1983 ( I . transplant: 116, 2. transplants: 20, 3 
transplants: 4, kidney and pancreas transplants: 6). A l l 
patients received at least 3 blood transfusions before 
transplantation. 
CsA: I 7 mg/kg body weight (b.w.) — 8-6 mg/kg b.w. 
MP:8 mg/kg daily from the beginning. 
Antirejection Therapy 
( I ) rejection episode: 3 x 500 mg methylprednisolone 
(MP) . (2) / (3) rejection episode: A L G + 120 mg MP 
over a period of 7 days. 
Historical Controls 
Historical controls were 277 patients treated with 
steroids and azathioprinc (July 1976 February 1982). 
Definition of the incidence of primarily nonfunctioning 
kidneys (ATN-kidneys): renal transplantation is a recip-
ient requiring at least one postoperative hemodialysis. 
Preservation of all Renal Transplants 
Preservation of all renal transplants was accomplished 
by using Euro-Collins' solution, for perfusion and after ice 
storage. 
A T N - i n c i d e n c e r e l a t e d to c o l d i s c h e m i a t i m e 
Fig. 1. ATN- inc idence (-=rate of primarily non-
functioning kidneys) related to cold ischemia t ime (CIT) . 
C y A . cyclosporine. 
From the Transplantation Centre Munich, Dept. of 
Surgery, Klinikum Großhadern, University of Munich, 
W. Germany. 
Reprint requests should be addressed to Prof. Dr. W. 
Land, Transplantation Centre, Klinikum Großhadern, 
Marchioninisir. 15, 8000 München 70 j W. Germany. 
© 1984 by Grune & St ration. Inc. 
0041 1345/84/1601 -0085$01.00/0 
Transplantation Proceedings, Vol. XVI , No. 1 (February), 1 9 8 4 2 8 5 
2 8 6 SIEBERT ET A L . 
o. 
> 20. Basic i.s. therapy 
* CyA plus Steroids C8mg/dally) 
w 
0 ' i ' 4 ' 6 1 A VoMon 12 
(March 83) 
Fig. 2. Graft survival rate in correlat ion to primarily 
functioning (nin-ATN)-nonfunctioning (ATN) kidneys. 
C y A , cyclosporine. 
RESULTS AND CONCLUSION 
With regard to our experience, there is a 
correlation between length of cold ischemia 
time and the incidence of nonfunctioning 
ATN-kidneys, regardless of whether the 
recipients were treated with C s A or conven-
tionally ( F i g . l ) . The number of ATN-kidneys 
increased from 29% in the group with the 
shortest cold ischemia time up to 81.8% for 
kidneys with an ice storage time over 36 hr. It 
has to be discussed that the high incidence 
(61.6%) of primarily nonfunctioning kidneys 
may be ascribed to the "Munich Moder' of 
organ harvesting, since about 70% of all donor 
nephrectomies are performed in smaller com-
munity hospitals. In those hospitals the ade-
quate handling of donors may not be sufficient 
(especially in intensive care). 
The results of cadaveric renal transplanta-
tion under C s A therapy are significantly 
Table 1. Graft Survival for A T N and non-ATN 
(March 1982 to March 1983) 
Lost Functioning Total 
ATN 24 2 6 . 7 % 66 7 3 . 3 % 9 0 6 1 . 6 % 
Non-ATN 6 1 0 . 7 % 5 0 8 9 . 3 % 56 3 8 . 4 % 
Total 30 2 0 . 5 % 1 16 7 9 . 5 % 146 1 0 0 % 
Bis: CsA + steroids. 
Table 2. Graft Function in C s A - T r e a t e d Recipients 
W i t h / W i t h o u t A T N Kidneys 
Creatinine Creatinine Creatinine 
(mg /100 ml) ( m g / 1 0 0 ml) (mg/100 ml) 
1 month 3 months 6 months 
ATN 3 .10 2 .39 2 .35 
V = 3.43 V = 1.28 V = 0 .78 
SDEV 1.85 SDEV = 1.13 SDEV = 0 .88 
n = 55 n - 5 2 n = 25 
Non-ATN 2 .12 2 .17 1.99 
V - 0 . 8 0 V = 1.33 V = 1.08 
SDEV = 0 .89 SDEV = 1.15 SDEV = 1.04 
n = 35 n = 35 n = 2 4 
V, variance. SDEV, standard deviation. N, number o f 
patients. 
Only patients w i th functioning grafts were observed at 
least 6 months after transplantation. 
poorer in patients having received A T N -
kidney transplants (15.2% difference in the 
graft survival rate; p = 0.04) (Fig. 2 and 
Table 1). The graft survival probability for 12 
months is only 66.8% for ATN-kidneys, but 
82% for non-ATN-kidneys. 
Further controls after 18 or 24 months will 
show whether the preliminary results remain 
the same. 
A short cold ischemia time in cadaveric 
renal transplants is certainly of great impor-
tance (fewer ATN-kidneys, better results), 
especially under C s A therapy (nephrotoxic 
side effects). 
As regards the late graft function (6 
months pop.) under C s A treatment, there 
seems to be no statistical difference between 
Table 3. Hepatotoxic Side Effect of C s A in Patients 
W i t h / W i t h o u t Preexist ing Liver Disease 
Bilirubin Bilirubin 
( m g / 1 0 0 m l ) (fig/100 ml) 
1 Month 3 Months 
Preex. hepatopathy 1.02 0 .98 
V = 0 .19 V = 0.45 
SDEV = 0 . 4 4 SDEV 0.67 
n - 17 n = 15 
Wi thout 1.14 0 .92 
preex. hepatopathy V = 0 .05 V 0.19 
SDEV = 0 .23 SDEV = 0.44 
n = 6 2 n - 56 
V, variance. SDEV, standard deviation, n, number of 
patients. 
CSA AND ATN KIDNEYS 2 8 7 
nonfunctioning (ATN)-k idney transplants 
and non-ATN-kidneys (Table 2). 
If the organs are not rejected before 6 
months, the creatinine values are nearly the 
same in A T N and non-ATN-kidneys, but 
26.7% of the ATN-kidneys are rejected within 
6 months posttransplant. 
Relevant hepatotoxic side effects could not 
be seen in our patients neither in the group 
with, nor in the group without preexisting 
hepatopathy (Table 3). 
Summing up, there remains the relevance 
of a short cold ischemia time (under 30 hr) for 
a lessened incidence of primarily nonfunction-
ing kidneys and a better graft survival. 
REFERENCES 
1. Sandoz Ltd. and participating centres; Lancet 2:57, 2. Land W, Castro LA, Miner W D , et al: Fortschr Med 
1982 41:1912,1982 


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Cyclosporine A in kidney-transplanted patients without initial diuresis.

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