This report describes a simple method for the bioremediation of selenium from agricultural drainage water. A medium-packed pilot-scale biological reactor system, inoculated with the selenate-respiring bacterium Thauera selenatis, was constructed at the Panoche Water District, San Joaquin Valley, Calif. The reactor was used to treat drainage water (7.6 liters/min) containing both selenium and nitrate. Acetate (5 mM) was the carbon source-electron donor reactor feed. Selenium oxyanion concentrations (selenate plus selenite) in the drainage water were reduced by 98%, to an average of 12 ؎ 9 g/liter. Frequently (47% of the sampling days), reactor effluent concentrations of less than 5 g/liter were achieved. Denitrification was also observed in this system; nitrate and nitrite concentrations in the drainage water were reduced to 0.1 and 0.01 mM, respectively (98% reduction). Analysis of the reactor effluent showed that 91 to 96% of the total selenium recovered was elemental selenium; 97.9% of this elemental selenium could be removed with Nalmet 8072, a new, commercially available precipitant-coagulant. Widespread use of this system (in the Grasslands Water District) could reduce the amount of selenium deposited in the San Joaquin River from 7,000 to 140 lb (ca. 3,000 to 60 kg)/year.

Programmed cell death protein 1 (PD-1) is a receptor found on T cells, and when bound with its ligand PD-L1 or PD-L2, it negatively regulates T cells. Certain tumors, such as squamous non-small cell lung cancer and melanoma, evade T cell immune surveillance by upregulating PD-1 ligands. Blockade of PD-1 and its ligand can restore T cell-mediated tumor suppression (1).

Plasmapheresis (PP) and intravenous immunoglobulin (IVIg) remove donor-specific antibodies, a cause of acute humoral rejection (AHR). We describe the use of PP and IVIg as rescue therapy for AHR. The records of 143 renal transplants performed between October 1, 2000 and April 1, 2002 were reviewed. Patients who underwent PP and IVIg therapy for AHR were identified. The data reviewed included age, sex, source of transplant, number of human leukocyte antigen mismatches, transplant number, number of PP and IVIg treatments, dose of IVIg, time of AHR, serum creatinine (SCr) level at AHR, SCr level after PP and IVIg at 3 months, days to achieve 30% decline in SCr, and graft survival. Immunosuppression included basiliximab induction, tacrolimus, and prednisone (+/- sirolimus or mycophenolate mofetil [CellCept, Roche Pharmaceutical, Nutley, NJ]). PP was followed by IVIg infusion. Nine patients were treated for AHR with PP and IVIg. All nine patients demonstrated biopsy-proven AHR. One graft was lost. Mean 3-month and 1-year SCr levels were 1.9 and 1.8, respectively, in the remaining eight patients. AHR in renal transplantation can be effectively treated with PP and IVIg.

There has been a dramatic increase in the utilization of kidneys from donors after cardiac death (DCD). While these organs represent an opportunity to expand the donor pool, the assessment of risk and optimal perioperative management remains unclear. Our primary aim was to identify risk factors for objective outcomes, and secondarily, we sought to determine what impact pulsatile machine perfusion (PMP) had on these outcomes. From 1993 to November 2008, 6057 DCD kidney transplants were reported to the Organ Procurement and Transplantation Network database, with complete endpoints for delayed graft function (DGF) and graft survival (GS). Risk factors were identified using a multivariable regression analysis adjusted for recipient factors. Age (50 yr) [OR 1.81, p < 0.0001] and cold ischemia time (CIT) (>30 h) [OR 3.22, p < 0.0001] were the strongest predictors of DGF. The use of PMP decreased the incidence of DGF only when donor age was >60 yr and improved long-term graft survival when donor age was >50 yr. Donor warm ischemia time >20 min was also found to correlate with increased DGF. While the incidence of DGF in DCD kidneys is significantly higher, the only factors the transplant surgeon can control are CIT and the use of PMP. The data suggest that the use of PMP in DCD kidneys <50 yr old provides little clinical benefit and may increase CIT.