Prevalence, etiology, and treatment of late post-transplant hypertension.
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Biomedical subjects
Publications and source records attributed to P Kinnaert.
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Fourteen adult patients were transplanted with a single pediatric kidney and were followed for 26 days to 9 years. Donor ages ranged from 22 months to 10 years, recipient ages from 15 to 47 years. Ten transplants functioned for more than one year. Three kidneys were rejected after 26 days, 3 months and 18 months. Three patients died 2, 6 and 13 months after transplantation from aspergillosis, cytomegalovirus infection and salmonellosis. Eight kidney grafts are currently functioning 2 to 9 years after transplantation. Serum creatinin levels range between 0.9 and 1.1 mg/dl in 7 patients. One woman with chronic rejection has a serum creatinin level of 2.5 mg/dl. A single pediatric kidney is able to sustain a satisfactory renal function in an adult recipient.
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Both kidneys of an anencephalic newborn were transplanted into a 23-year-old male patient. Hemodialysis was required for 3 weeks postoperatively. Both organs increased in size but did not reach the normal volume of an adult kidney. 3 years post-transplantation, the patient is doing well with a plasma creatinine level of 1.5 mg/dl. Technical problems are discussed.
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Eighty-five patients were followed up at least 1 year after creation of an arteriovenous fistula in the forearm. The anastomosis was side-to-side in 33 patients, end-to-side in 33 and end-to-end in 19. Trophic lesions were not observed. Intermittent claudication of the hand was more frequent in patients with a side-to-side arteriovenous fistula (42 percent) than in those with end-to-side (21 percent) or end-to-end fistulas (16 percent). Clinical and x-ray studies indicate that two different mechanisms are responsible for cramping pains: arterial steal phenomenon and venous hypertension. Their relative importance depends on multiple hemodynamic factors that may vary with time.
The humoral response after an intravenous injection of 10(9) sheep red blood cells was studied in a control group of rats and in rats submitted to three types of surgical procedures. The operated upon rats had an increased antibody synthesis, and this enhancing effect seemed to be proportional to the intensity of surgical trauma. The stimulatory effect of operation was also observed when the antigen was administered in the operative field.
Three clinical pictures were found in ten cases of listeriosis after renal transplantation: septicemia (six cases), meningo-encephalitis (three cases) and asymtomatic but recurrent bacteriuria (one case). Several features demonstrate profound immunologic disturbances in the recipient: close relationship in 9 cases out of 10 between infection and high doses of immunosuppressive drugs, unfavorable outcome of graft (accelerated rejection in 4 cases out of 10) and association in one case with lethal pulmonary infection due to opportunistic agents (cytomegalovirus and Pneumocystis carinii).
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Liver dysfunction was observed in 33% of patients treated by hemodialysis and kidney transplantation. Fifty-eight percent of these cases of hepatitis occurred in patients with past or present HBs antigenemia, and 77% of HBsAg-positive patients showed evidence of LD. However, during the course of a program conducted from 1969 to 1976 and involving 267 patients, the decrease in the prevalence of HBs antigenemia observed during the last two years did not lead to any reduction in LD incidence. In a small number of patients, potentially hepatotoxic drugs could be incriminated, but in our experience azathioprine never appeared to be involved. In a few patients, LD was due to granulomatous disease of the liver, such as tuberculosis and schistosomiasis. Twenty-one (7%) of the 267 patients at risk developed chronic hepatitis, which contributed to death in nine patients. In 12 cases (three deaths), this form of hepatitis occurred in HBsAg-positive patients, and in nine cases (six deaths), in HBsAg-negative patients. In three of these latter individuals, cytomegalovirus could be incriminated. Routine monthly screening for CMV in kidney recipients confirmed the high incidence of this viral infection in such patients. Studies on murine CMV infection have demonstrated that this infection can be enhanced by histoincompatible graft or by cyclophosphamide in a model that is very close to the kidney recipient. As in mice, CMV infection in kidney recipients apparently results from reactivation of a latent infection. It seems to play a major role in the LD observed and could apparently lead to chronic hepatitis and even to cirrhosis of the liver. Finally, the occurrence of LD in HBsAg-, anti-HBs- and antiCMV-negative patients would suggest the responsibility of other viruses for the pathogenesis of liver disease in patients treated by hemodialysis and kidney transplantation. Besides Epstein-Barr virus, other viruses, such as hepatitis C virus, should be thoroughly scrutinized.