PubMed · 7628839
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G J Davis. 1995. The ultimate gift.. https://doi.org/10.1016/0046-8177(95)90215-5
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BACKGROUND: With the exception of primary central nervous system tumors, organ recovery is no longer considered from donors with known malignancy. Because intrathoracic and intraabdominal organs are usually recovered before the kidneys, we examined the incidence of renal cell carcinoma in cadaveric donor kidneys at the time of organ recovery. This would establish the theoretical risk of transplanting donor organs from a patient with a known renal malignancy. METHODS: In cooperation with the Louisiana Organ Procurement Agency, we reviewed the records of all patients who were cadaveric kidney donors in the state of Louisiana between September 1991 and October 1997. Information was reviewed and analyzed on donor age, sex, race, past medical/surgical history, cause of death, and the findings at the time of organ recovery. RESULTS: A total of 553 consecutive cadaveric donors were identified, with 1106 kidneys recovered. Of the 553 cadaveric donors, 5 (0.9%) were noted to have an incidental renal cell carcinoma. All tumors were identified in separate donors; that is, none of the tumors were bilateral. None of the five donors had documented symptoms referable to their urinary tract. All tumors were either T1 or T2 by the tumor, node, metastasis classification system, and no evidence of nodal or distant metastatic disease was present. In one case, the contralateral kidney, heart, and liver were transplanted before the tumor was identified. In the remaining four cases, all organs (renal and nonrenal) were discarded. CONCLUSIONS: Renal cell carcinoma is rarely found during renal recovery from a cadaveric donor. However, because the kidneys are usually recovered after the intrathoracic and intraabdominal organs, careful palpation of the kidneys and exploration of any abnormalities is mandated to avoid transplanting any organs from a donor with a known renal malignancy.
BACKGROUND: Low recipient age is still a risk factor for graft failure after kidney transplantation (Tx). Detailed prospective reports on long-term graft function in small children after renal Tx are still lacking. METHODS: Forty-nine kidney allograft recipients who received transplants before the age of 5 years were followed prospectively. The most common disease was congenital nephrotic syndrome of the Finnish type. Twenty patients were recipients of living related donors (LRD), and 29 were cadaveric kidney (CAD) recipients. All patients received triple immunosuppression. Glomerular filtration rate (GFR), effective renal plasma flow (ERPF), sodium, urate, and potassium handling, and concentrating capacity were studied for up to 7 years after Tx. RESULTS: Patient survival 7 years after Tx was 100% for LRD and 96% for CAD recipients. Graft survival was 94% for LRD and 79% for CAD recipients (P=NS) and 89% and 83% for children >2 years and <2 years of age at Tx, respectively (P=NS). Five years after Tx, GFR was 70 vs. 64 and ERPF was 380 vs. 310 ml/min/1.73 m2 for LRD and CAD recipients, respectively (P=NS). Mean absolute GFR remained stable. GFR was lower in children who received transplants at <2 years than in children who received transplants at >2 years of age, 54 vs. 75 ml/min/1.73 m2 (P=0.02). Sodium handling remained intact, but hyperuricemia was seen in 43-67%; 17-33% showed abnormal handling of potassium; and most patients had a subnormal concentrating capacity. CONCLUSIONS: Excellent long-term graft survival and good graft function can be achieved with triple immunosuppression, even in young CAD kidney recipients.
PURPOSE: To review the radiation therapy "box" technique for cancer of the cervix by means of magnetic resonance imaging (MRI), lymphangiography, and anatomic studies on cadavers. METHODS AND MATERIALS: From 1993 to 1996, the anatomic borders of the "box" technique used at our Radiation Oncology Department-the superior border of the AP-PA fields at the inferior edge of L4; the inferior border at the inferior edge of the ischium; the lateral borders placed 2.5 cm outside of the bony pelvis rim; the anterior border of the lateral fields over the anterior edge of the pubic symphysis; and the posterior at the S2-S3 interspace-were reviewed in 35 sagittal MRI and 10 lymphangiographies of patients with FIGO IB (6), IIA (6), IIB (19), IIIB (3), and IVA (1). An anatomic revision was conducted on 30 cadavers to identify aortic bifurcation, lymphatic nodes, and uterus flexion. RESULTS: In 50% of the patients with FIGO IB, the posterior border of the lateral field was inadequate to encompass the planning target volume (PTV), and in 67% with Stage IIA. In IIB, the anterior border was inadequate in 1 patient, and the posterior in 8 (42%). In IIB and IVA patients, the PTV was not encompassed. When correlating the anterior and posterior borders of the lateral field and the treatment volume in the 35 sagittal MRIs, the posterior border of the lateral field was inadequate in 49%, and the anterior border in 9% of the cases. According to the lymphangiography, the portals encompassed the external iliac nodes. Dissected female pelvises revealed that the aortic bifurcation occurred at the level of the inferior L4 edge in 80% of the cadavers. There was no correlation between uterus flexion in MRIs and in cadavers. CONCLUSION: The design of the lateral fields of the four-field technique for the irradiation of the uterine cervix based on anatomic bone references failed to encompass the planning-target volume in a significant number of patients.