Living related donor (LRD) nephrectomies are controversial due to the risks to the donor and improved cadaveric graft survival using cyclosporine A. Between December 22, 1970, and December 31, 1984, 1096 renal transplants were performed at a single institution, 314 (28.6%) from LRD. The average age was 34.3 years (range: 18-67); none had preoperative hypertension. All nephrectomies were performed transabdominally. Major perioperative complications occurred in 22 (7.0%). These include wound infections (3.5%), pancreatitis (1.0%), injuries to spleen (1.0%) or adrenal gland (0.3%) requiring removal, pneumonitis (0.6%), ulnar nerve palsy (0.6%), femoral artery thrombosis after arteriogram (0.3%), pulmonary embolus (0.3%), and upper pole infarct of contralateral kidney (0.3%). There are six known deaths in this series, none of which were related to the operation. Major late complications were seen in 50 (20.0%) of 250 patients followed for 6 to 175 months (mean 53.1 months). These included definite hypertension (5.6%), suture granuloma (4.4%), incisional hernia (3.6%), proteinuria (2.4%), bowel obstruction (2.0%), nephrolithiasis (1.2%), wound infection (0.4%), scrotal hydrocele (0.4%), and chronic pancreatitis (0.4%). While the risk of hypertension appears to increase as the interval from donation increases, no cases of renal failure after donation have been noted, and negligible proteinuria among those followed long-term has been seen in this series. It is felt that living related kidney donation is justified when the relative is sincerely motivated and well informed prior to donation.

Transport of biotin across human intestinal brush-border membrane (BBM) was examined using brush-border membrane vesicle (BBMV) technique. Uptake of biotin by BBMV is mostly the result of transport of the substrate into an active intravesicular space with little binding to membrane surfaces. The transport of biotin was carrier mediated and was 1) Na+ (but not K+) gradient dependent with a distinct "over-shoot" phenomenon, 2) saturable as a function of concentration in the presence of a Na+ (but not a K+) gradient with an apparent Km and Vmax for the Na+ gradient-dependent system of 5.26 microM and 13.47 pmol.mg protein-1.20 s-1, respectively, and 3) inhibited by structural analogues and related compounds. Unlike the electrogenic transport of D-glucose, transport of the anionic biotin in the presence of a Na+ gradient (out greater than in) was not affected by imposing a relatively positive intravesicular electrical potential, suggesting that biotin transport is most likely an electroneutral process. These results demonstrate the existence of a carrier-mediated system for biotin transport in human BBM and show that the transport process is Na+ gradient dependent and electrically silent. It is suggested that biotin transport across the BBM is driven by a Na+ gradient most probably through a biotin-Na+ cotransport system.

Serum sickness is an immune-complex mediated illness that frequently occurs in patients after polyclonal antibody therapy (ATGAM or thymoglobulin). Serum sickness presents with significant morbidity but is self-limited and resolves with prolonged steroid therapy. We present five renal transplant patients who developed serum sickness after polyclonal antibody treatment with severe symptoms that persisted after being started on systemic steroids. These patients underwent one or two courses of therapeutic plasma exchange (TPE) with subsequent complete resolution of their symptoms. Renal transplant recipients with serum sickness after polyclonal antibody therapy may benefit from TPE by accelerating their time to recovery and thereby reducing overall morbidity.

Surgery specialty-specific risk factors of 30-day post-operative SSI rates have been identified for a variety of surgery specialties. Accurate SSI risk-predictive surgery specialty-specific SSI predictive models have been developed and validated for the VHA surgery population. These models can be used to develop optimal preventive measures for high-risk patients, patient-centered care planning, and surgical quality improvement.

The number and class of antibiotics administered after surgery, preoperative length of stay, procedural characteristics, surgical program complexity, and patient comorbidities are associated with postoperative CDI in the VHA.

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A CI-free protocol with antibody induction and sirolimus results in low rates of AR and PNF and excellent early patient and graft survival in patients with MDK and DGF. CI-free protocols may allow expansion of the kidney donor pool by encouraging utilization of MDK at high risk for DGF or CI-mediated nephrotoxicity.