In 61 patients (167 examinations) the pulsatile flow index (PFI) was used to diagnose the cause of renal transplant dysfunction. The results were correlated with histology and clinical course and outcome, angiography or quantitative radionuclide renography. Renal transplant rejection was diagnosed by PFI with a sensitivity of 85%. The specificity was 81% and the diagnostic accuracy 83%. The positive predictive value was found to be 76%, whereas the negative predictive value was 89%. In presence of acute tubular necrosis (ATN) the PFI was normal in 89% of examinations and therefore distinguishable from acute rejection.
Thirty new malignant tumours were found in 1080 patients (634 men, 446 women; mean age 37.6 +/- 13.6 years) after a median follow-up period of 5 years following 1245 cadaveric kidney transplantations performed between 1972 and 1990. The mean dialysis period before transplantation had been 4.0 +/- 3.1 years. Regarding the type of tumour, carcinomas were by far the most frequent, while there was only one lymphoma. The annual malignancy incidence for renal transplant patients was 0.5%. This is 3.5 times higher for men and 4.2 times for women than in the normal population. Immunosuppression with azathioprine and/or antithymocytic globulin (n = 395) produced the same malignancy incidence (0.54%) as with cyclosporin (n = 685; 0.60%). On the other hand, malignant tumours occurred much earlier under cyclosporin than under azathioprine/antithymocytic globulin (27 and 68 months, respectively).
In a retrospective study of 814 patients (349 women, 465 men) who had received their first kidney transplant, early function rate as well as transplant and patient survival rates were determined in relation to age (up to 50 years: 530; 51-55 years: 140; 56-60 years: 83; over 60 years: 61). The same rates were also grouped by donor age (> 16 years, 68 patients; 16-40 years, 387; 41-50 years, 165; 51-60 years, 144; over 60 years, 50). The 5-year transplant function rate fell significantly with increasing donor age (P = 0.0001) from 78% (16-40 years) to 47% (over 60 years). For the same age groups the proportion of transplants which never resumed their function rose from 8 to 28%. Age of recipient had no influence on early function and 5-year transplant function rates. Thus, regardless of the recipient's age, higher donor age is an independent risk factor for early and late results after transplantation.
In a prospective study, 44 patients (11 women, 33 men) who had received orthotopic liver transplants underwent a total of 196 consecutive duplex Doppler ultrasound examinations. The aim of the study was to evaluate the correlation between the pulsatile flow index (PFI) and the damping index (DI) as far as complications as rejection or cholangitis were concerned. The patients were examined five times each on average. The PFI and DI were measured in the hepatic artery, the portal vein and the hepatic veins. The findings were compared with the clinical course (cholangitis, rejection) and the histomorphological diagnosis as determined in biopsy specimens. In biopsy-proven rejection episodes, the sensitivity of the PFI in the hepatic artery was 69.4%, the specificity 72.2%. The sensitivity of the DI in the hepatic vein was 89.4%, the specificity 89.1%. Combining the two, specificity was more than 90%. PFI and DI in the portal vein bore no apparent relation to clinical course or histomorphological diagnosis. We found duplex Doppler ultrasound extremely beneficial in determining the timing and indication for liver biopsy. In addition, this simple examination, which can be performed as often as desired, accurately shows the transplanted liver's response to measures taken to counter rejection.
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