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.
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).
Twenty‐six insulin‐dependent patients with diabetes mellitus have been treated for end‐stage renal failure during a 5‐year period. The cause of this failure was diabetic nephropathy in 24 cases. Eleven patients were temporarily treated with diet alone for their uraemia; 23 patients, 7 of whom had previously been treated with diet alone, were treated with dialysis and 9 of these patients were later subjected to kidney transplantation. One patient received a kidney graft directly, while his uraemia was treated with diet alone. At the time of initiation of the treatment for renal insufficiency, the diabetes had lasted for 22 years and the kidney disease for 5 years (average values). Peritoneal dialysis presented no complications. The main problem with haemodialysis was difficulty with the arteriovenous shunt. The regulation of the diabetes caused problems in all 10 patients subjected to kidney grafts; all required increased doses of insulin. Infection and hypertension were prevalent among these patients, while rejection of the graft occured in only 2 cases. No definite changes were found in the cardiac status, retinal changes or BP during treatment. The average period of observation for all 26 patients was 10 months. The total mortality was 65%; approximately half of the deaths were due to cardiovascular causes and about 1/3 to infection. The cumulative survival after 3 years was 25% for all patients and 41% after 2 years for the graft recipients. The present investigation shows that both dialysis and kidney transplantation are possible in patients with diabetes mellitus and end‐stage renal failure. The goal of future treatment must therefore be kidney transplantation, as it makes it possible to offer the patient an acceptable life.
The symptoms and diagnosis of perirenal lymphocele following kidney transplantation are discussed. A case demonstrated by means of i.v. urography and gamma camera scintigraphy is reported. The value of the last mentioned method is stressed.
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