The theory that cancer may arise under conditions of reduced immune capacity is supported by observations of humans with immune deficiencies such as occur following organ transplants. However, no study on humans has been done in which the reference population was the same as that in which the cancer cases arose and in which there was a sufficiently long period of follow-up. Information on 5,692 Nordic recipients of renal transplants in 1964-1982 was linked with the national cancer registries (1964-1986) and population registries. Person-years at risk were calculated from the date of first transplantation until death or the end of the study period and were multiplied by the appropriate age- and calender-specific incidence rates to obtain the expected numbers of cancers. Standardized incidence ratios (SIR) were calculated after stratification by a number of recorded variables. Altogether, 32,392 person-years were accrued, and 471 cancers occurred, yielding overall SIR of 4.6 (95% CI, 4.0 to 5.2) for males and 4.5 (95% CI, 4.0 to 5.2) for females. Significant overall 2- to 5-fold excess risks in both sexes were seen for cancers of the colon, larynx, lung and bladder, and in men also for cancers of the prostate and testis. Notably high risks, 10-fold to 30-fold above expectation, were associated with cancers of the lip, skin (non-melanoma), kidney and endocrine glands, also with non-Hodgkin's lymphoma, and in women also with cancers of the cervix and vulva-vagina. Among a number of donor and recipient variables studied, including tissue types and compatibility (ABO, HLA, DR), age below 45 years at the time of transplantation was the most important determinant for increased risk at most sites. Kidney transplantation increases the risk of cancer in the short and in the long term, consistent with the theory that an impaired immune system allows carcinogenic factors to act. The tumor risk is small in comparison with the benefits of transplants, but patients should be followed up for signs of cancer.

We conclude that the new fluid with a higher pH and less GDPs is safe and easy to use and has no negative effects on either the frequency of peritonitis or peritoneal transport characteristics as compared with conventional ones. Our results indicate that the new solution causes less mesothelial and interstitial damage than conventional ones; that is, it may be considered more biocompatible than a number of conventional PD solutions currently in use.

Objective The goals for maintenance dialysis treatment are to improve patient survival, reduce patient morbidity, and improve patient quality of life. This is the first randomized prospective study comparing automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) treatment with respect to quality of life and clinical outcomes in relation to therapy costs. Design A prospective, randomized multicenter study. Setting Three Danish CAPD units. Patients Thirty-four adequately dialyzed patients with high or high-average peritoneal transport characteristics were included in the study. Twenty-five patients completed the study. Interventions After randomization, 17 patients were allocated to APD treatment and 17 patients to CAPD treatment for a period of 6 months. Medical and biochemical parameters were evaluated at monthly controls in the CAPD units. Quality-of-life parameters were assessed at baseline and after 6 months by the self-administered short-form SF-36 generic health survey questionnaire supplemented with disease- and treatment-specific questions. Therapy costs were compared by evaluating dialysis-related expenses. Main Outcome Measures Quality-of-life parameters, dialysis-related complications, dialysis-related expenses. Results The quality-of-life studies showed that significantly more time for work, family, and social activities was available to patients on APD compared to those on CAPD ( p < 0.001). Although the difference was not significant, there was a tendency for less physical and emotional discomfort caused by dialysis fluid in the APD group. Sleep problems, on the other hand, tended to be more marked in the APD group. Any positive effect of APD compared to CAPD on dialysis-related hospital days or complication rates could not be confirmed. With larger patient samples, it is possible, however, that a significant difference might have been achieved. The running costs for APD treatment were US $75 per day and for CAPD treatment US $61 per day. Conclusion If APD treatment can help to keep selected patients vocationally or socially active, paying the extra cost seems reasonable.

Denneberg, T., Friedberg, M., Holmberg, L., Mathiasen, C., Nilsson K. O., Takolander, R. and Walder M. (Departments of Nephrology, Paediatrics, Surgery and Clinical Bacteriology, Malmo Allmiinna Sjukhus, Malmo, Sweden). Combined plasmapheresis and hemodialysis treatment for severe hemolytic-uremic syndrome following Campylobacter colitis. Acta Paediatr Scand, 71: 243, 1982.-A case of severe hemolytic-uremic syndrome (HUS) with long lasting anuria in a 7 month old patient is described. The patient failed to improve until treated with combined plasmapheresis and hemodialysis. Declining titres against Campylobacter jejuni/coli suggest that this was the causal agent. We feel that plasmapheresis should be tried in severe HUS with prolonged anuria, which has a poor prognosis with conventional treatment.

The serum levels of 25-hydroxycholecalciferol (25-OHD₃) and 1,25-dihydroxycholecalciferol [1,25-(OH)₂D₃] were measured simultaneously in nephrectomized patients on maintenance haemodialysis, in haemodialyzed patients with preserved kidneys who were receiving different vitamin D supplement, and in patients who had undergone renal transplantation. The results indicate that the production of 1,25-(OH)₂D₃ can be stimulated in patients with minimal residual renal excretory function by increasing the serum levels of 25-OHD3. Successful renal transplantation was followed by a rise in serum 1,25-(OH)₂D₃ concentrations.