Blood transfusion does not influence the development of malignant tumours.

OBJECTIVE: To investigate whether blood transfusion given to women during childbirth favours tumour development in later life. DESIGN: Retrospective cohort study. SETTING: County hospital, Sweden. SUBJECTS: 621 women who were given blood transfusions during childbirth compared with 1216 matched controls who were not given transfusions at the time of delivery. MAIN OUTCOME MEASURES: Overall and cancer-specific mortality, cancer morbidity, time interval between transfusion and diagnosis or death from cancer. RESULTS: After 21-31 years of follow-up of cancer morbidity and 22-32 years of overall and cancer-specific mortality, we found no significant differences between the groups. There were no differences in time from transfusion to diagnosis of malignant disease, or in time from transfusion to death from cancer. CONCLUSION: Blood transfusion given to women during childbirth does not promote malignant tumour development in later life, nor does it increase cancer mortality.

Factors reducing mortality in typhoid ileal perforation.

A retrospective study of 42 patients treated surgically for typhoid ileal perforation found the mortality to be 24%. The study suggested that general peritonitis was the main cause of death in typhoid ileal perforation. However, the high mortality was significantly improved by adequate preoperative rehydration. The combination of chloramphenicol/gentamicin/metronidazole was superior to other antibiotic regimes. No mortality was recorded with this triple drug therapy.

Outcome of pancreas transplantations in Göteborg, Sweden 1985-1990.

During 1985 to 1990, 67 segmental pancreas transplantations with bladder drainage were performed. Fifty were combined pancreas and kidney and 17 were pancreas after kidney transplants. All patients were transplanted with the same technique. The 1-year actuarial pancreas graft survival for the combined patients with quadruple immunosuppressive therapy was 83% and the patient survival, 95%. The most important complications were infections, leakage from the pancreatico cystostoma and vascular complications.

Transplantation in patients with diabetic nephropathy. Outcome of combined pancreas and kidney transplantation compared with kidney transplantation only.

Detailed results of 12 combined pancreas and kidney transplantations (Comb) were compared with those of two matched diabetic controls per patient--one living donor kidney recipient (LD) and one cadaveric donor kidney recipient (CD--who, though eligible for pancreas transplantation also, preferred kidney transplantation only. Mean follow-up was 22, 23, and 21 months in the three groups. There was no mortality in the LD group, but two CD and one Comb patient died from cardiovascular disease. Two kidneys were lost in both the Comb and the LD group, compared to five in the CD group. Ten major vascular events occurred and three of them were lethal. The only LD case was one below-knee amputation; the other nine were equally distributed in the Comb and CD groups. The time spent in the hospital was shorter for the LD group. Thus, in the short run, LDs confer the best results, whereas in the long term the better metabolic control in the Combs may prove favorable.

del(3p)(p13p21) in renal cell adenoma and del(4p)(p14) in bilateral renal cell carcinoma in two unrelated patients with von Hippel-Lindau disease.

Karyotype analyses of renal cell adenoma in one patient and bilateral renal cell carcinomas (RCC) in another unrelated patient have been performed. Both patients belonged to families with von Hippel-Lindau disease (vHL). In the adenoma, we found a clonal del(3)(p13p21) and a small clone of two cells with an additional del(14)(q13). This result indicates that the same region that is often deleted in RCC may also be deleted in a renal cortical adenoma. This finding may facilitate the localization of a tentative renal cell adenoma/carcinoma tumor suppressor locus. In the tumors from the patient with bilateral carcinomas we found a clonal del(4)(p14) on one side and on the other a del(4)(p14) together with del(14)(q13). In this case, there was no detectable 3p defect in the tumors. This result raises the question whether an alternative/additional locus on chromosome 4p may be involved in the RCC/vHL syndrome. Constitutional karyotypes were in both cases normal.

Glomerular structural quantities in baseline biopsies from cadaveric donor kidney pairs.

Glomerular structural parameters were estimated in kidney biopsies from 11 cadaveric donors at the time of transplantation. The main purpose was to compare the biopsies from the right and left kidney from each donor. Mean glomerular volume was determined by light microscopy. The ultrastructural parameters were basement membrane thickness and volume fractions of mesangial regions with either the tuft or total glomerulus, (i.e. the tuft plus the urinary space in between the capillaries) as reference spaces. Further, the mesangial composition was determined as the volume fraction of basement membrane-like material to total mesangial regions (Vv(BMLM/mes]. The structural quantities conformed with those obtained in living kidney donors. The coefficient of variation (CV) for the group of 11 cases was highest for the mean glomerular volume (0.26) and lowest for the Vv(BMLM/mes) (0.10). The coefficient of error (CE) of the two independent determinations of structural parameters in each individual was well below 5%. The findings therefore demonstrate that, with the methods used, a renal biopsy gives valid and reliable information for that particular individual - at least in cases with 'normal' structures.

Severe kidney graft rejection in combined kidney and pancreas transplantation.

With a low dose, triple drug protocol for immunosuppression, more frequent and severe rejection episodes, and lower, kidney graft survival appeared after combined kidney and pancreas transplantation than after kidney transplantation alone. With increased immunosuppression using the quadruple drug protocol that includes prophylactic ATG treatment, the results after combined transplantations improved.

Survival in end-stage diabetic renal disease. A prospective study of 100 kidney transplant patients.

The results of renal transplantation in patients with diabetes mellitus were studied in 100 consecutive patients transplanted between Dec. 1972 and June 1982. The study period was divided into two parts, 1972-76 (era I, 21 patients, 18 with juvenile onset diabetes) and 1977-82 (era II, 79 patients, 72 with juvenile onset diabetes). A group of 168 non-diabetic patients, aged 20-54 years, receiving primary grafts during the same period served as controls to the 72 juvenile onset diabetics from era II. The three-year actuarial patient survival of transplanted diabetics improved from 48% during era I to 76% during era II and was then not significantly inferior to that of the non-diabetic controls. The three-year actuarial graft survival rate was significantly higher for recipients of kidneys from living related donors than for those who had received kidneys from cadaveric donors (CD) among both diabetic and non-diabetic patients. However, the three-year graft survival rate was significantly higher (56%) for non-diabetic than diabetic CD recipients (37%). The overall survival in diabetes mellitus was strongly influenced by the outcome of retransplantation during era II (12 patients). Thus, 69 patients were alive, 64 with a functioning graft, at the end of the observation period.

Clinical experience of blood transfusion in renal transplantation.

A positive effect on survival of renal grafts of pretransplant blood transfusions have been reported from several centers. The aim of this study was to study if the described graft-protecting effect of blood transfusion was present in the Gothenburg material of transplanted patients, and if this effect could be achieved by deliberately transfusing previously non-transfused patients with two units of leukocyte-reduced blood. The effect on graft survival (GS) of the number and timing of transfusions to recipients, transfusions to the cadaveric donors, HLA-A, B matching, lymphocytotoxic antibodies and pretransplant hemodialysis was also studied. The study includes 844 recipients of primary renal grafts from living related and cadaveric donors (LRD, CD) and 70 patients waiting for transplantation. In the retrospective part of the study the GS of previously transfused and non-transfused non-transfused patients was compared. In the prospective part of the study a protocol with two deliberate transfusions (DT) to previously non-transfused patients was introduced. The GS of the DT group was compared to that for patients transfused for strictly medical reasons (MT) and non-transfused patients (NT). Survival of patients and grafts was calculated according to the life table method. In the retrospective part of study one year GS in LRD transplantation was 86.6% for transfused and 38.4% for non-transfused patients (P less than 0.01). In the first period one year GS in CD transplantation was 62.1% for transfused and 35.1% for non-transfused patients (P less than 0.01). The corresponding figures in the second period were 68.1% and 39.5%, respectively (P less than 0.001). In transfused recipients receiving kidneys from transfused and non-transfused cadaveric donors, the GS was 76.3% and 55.4%, respectively (P less than 0.05). In the prospective part of study the one year GS after LRD transplantation was 85.0% in both the DT and MT groups. In CD transplantation the one year GS was 73.4% and 75.7% of the DT and MT groups, respectively. The GS of each of these two groups was significantly better than that of 20.8% for the NT group (P less than 0.01). Lymphocytotoxic antibodies were detected in 5.0% of the DT group and 23.0% of the MT group (P less than 0.001). Foreign HLA-B series antigens had a negative influence on GS in the first period of the retrospective CD study. Later, no influence on GS was noted of HLA-A, B matching. Hemodialysis prior to transplantation did not influence GS.(ABSTRACT TRUNCATED AT 400 WORDS)