Immunosensitization against the human lymphocyte antigen (HLA) is a problem in most transplant centers. It prolongs the waiting list time in addition to risk of frequent acute rejections. To avoid these problems, various pretransplantation approaches have been attempted e.g. plasmapheresis (PP). The present retrospective study reports our experience with PP in this respect over a 5 year period. Twenty-three chronic hemodialysis patients with circulating panel reactive antibodies (> or = 50%) and previous kidney graft rejections were treated with 12 PP each. In addition to this, immunosuppression with cyclophosphamide and prednisolone were administered on the first day of PP and after tapering continued until transplantation. HLA-antibodies, as measured by the panel reactive antibodies and the antibody titer, decreased from about 70% to 30% (p < 0.001) and 5 steps of titerdilution, respectively with PP and immunosuppressive drugs; Twenty-two patients were transplanted with cadaveric grafts. Eight grafts were lost due to irreversible rejection, and one due to the patient's death 2 months after transplantation. The cumulative five-year graft survival at the time of follow-up was 59%. Adequate kidney function (serum creatinine mean 150 mumol/l) was observed in all grafts (n = 3) still functioning 60 months posttransplant. We conclude that pretransplantation plasmapheresis together with immunosuppressive drugs (cyclophosphamide and prednisolone) is useful in the removal of HLA antibodies in immunized patients awaiting kidney transplantation. It can be considered a valuable approach to increase the chances of successful transplantations.

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

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The efficacy of plasma perfusion through a new anionic resin, BR-350, for palliation of intractable pruritus secondary to intrahepatic cholestasis was studied in four patients. The treatment was given in a daily 2-h session on 3 consecutive days and was followed by repeated treatment periods each 3rd to 4th week. The patients experienced symptomatic improvement during the first treatment period, and the treatment was well tolerated. Adsorption of bile acids across the filter was efficient and resulted in a bile acid concentration gradient pre- to post-resin of 92%. Thus plasma perfusion through the ion resin BR-350 is an effective and safe treatment for symptomatic relief of intractable pruritus in cholestatic liver disease and may reduce hospitalization time and increase the quality of life.

1-908261 Scand J Urol Nephrol24Scand J Urol Nephrol Downloaded from informahealthcare.com by McMaster University on 12/08/14For personal use only. 22. Wheeler DC, Feehaly J , Walls J . High risk acute renal 1985: 175-183. failure. Q J Med 1986; 61: 977-984. Scand J Urol Nephrol24 Scand J Urol Nephrol Downloaded from informahealthcare.com by McMaster University on 12/08/14 For personal use only.