The clinical indications for and the timing of removal of non-functioning cadaver kidney transplants were studied in 49 of 58 kidneys which had never functioned or which ceased to function in the period 1979-1982. The reason for graftectomy was rejection in 32 cases, rejection and graft infection in eight, surgical complications in eight cases and infection in one case. Nine of the 58 failed kidney grafts were not removed. Graftectomy was performed within a week after diagnosis of graft failure in 24 of the 49 cases. The clinical indications for graftectomy were compared with the morphologic observations in the grafts. Discrepancy was greatest in regard to diagnosis of rejection and primary renal artery thrombosis. Severe complications related to graft failure aggravated the condition in 17 patients and resulted in eight deaths. Based on the findings, a management schedule is proposed. It facilitates postponement or avoidance of graftectomy and minimizes the risk of complications relating to failure of graft function.
Fungal arthritis (FA) due to a candida infection was reviewed in English literature and described in 45 cases. The increasing use of potent antibiotics, immunosuppressives, and especially the use of artificial joints, predisposed to the infection. Weightbearing joints, particularly the knees, were most frequently affected. Symptoms were described as a warm, tender and swollen joint, and the duration of symptoms prediagnosis was described as being up to 4 years. Amphotericin B was the treatment drug of choice, and in cases of no response, supplemented with either flucytosine or ketoconazole. Local FA healed in all cases. FA in an artificial joint resulted in all cases in removal of the prostheses. Mortality in systemic fungal infections including FA was 50%.
Urinary tract infection and rejection in 48 renal transplant patients immunosuppressed with cyclosporine-A monotherapy were analysed. Urinary tract infection was diagnosed in 52% of the cases with Escherichia coli dominating. Urinary tract infection took a mild and relatively uncomplicated course as only one case of graft pyelonephritis caused graft nephrectomy and no influence on graft survival was observed (p greater than 0.05) in the infected cases in contrast to rejection episodes which caused a significantly reduced graft survival (p less than 0.01).
The occurrence of recovery of kidney function after cessation of graft function or prolonged dialysis treatment has been studied retrospectively, and the frequency was found to be roughly 1%, inasmuch as 8 of approximately 750 patients could dispense with dialysis after 10-131 weeks of treatment. The causes of recovery of kidney function are discussed, as the importance of keeping this possibility in mind.
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