[Prospective study of a triple immunosuppressive combination in renal transplantation: cyclosporin A-corticoids-azathioprine]. / Etude prospective d'une triple association immunosuppressive en transplantation rénale: cyclosporine A-corticoïdes-azathioprine.

Cyclosporin A significantly improves patient and graft survival as compared with the conventional corticosteroid-azathioprine treatment. However, the results are the same, or even worse, when the cyclosporin A-corticosteroid regimen is compared with the corticosteroid-azathioprine-antilymphocyte globulin regimen. The authors have investigated a prednisone-azathioprine-low dose cyclosporin A combination in 46 high risk patients from a series of 117 renal transplantations performed in 1983. The actuarial patient and graft survival rates were as good as, but not better than, those obtained in 1982 in 106 patients treated with the conventional regimen which includes antilymphocyte globulin; they were 96.5% vs 98% and 85.5% vs 84% respectively at 6 months; 96.5% vs 98% and 83.5% vs 84% respectively at 12 months. The low dosage utilized (8 mg/kg instead of the usual 14-17 mg/kg) avoided virtually all the extrarenal side-effects of cyclosporin A, but not its nephrotoxicity. The theoretical risk of excessive immunosuppression was not confirmed by our study. Since cyclosporin A is very expensive, other therapeutic methods for optimal usage of that drug should be investigated.

[Continuous ambulatory peritoneal dialysis before renal transplantation]. / Dialyse péritonéale continue ambulatoire avant transplantation rénale.

In order to evaluate precisely the place of continuous ambulatory peritoneal dialysis in the treatment of chronic renal failure, it is important to find out whether this method may produce complications, mostly infectious, after renal transplantation. From April, 1979 to December, 1983, 419 renal transplantations were performed in our centre; 17 of these patients had previously been treated with peritoneal dialysis over a mean 13.5 months period, with 3.2 peritonitis/patient. The peritoneal catheter was left in situ for 4 to 16 weeks post-graft, so that the patients could easily be dialysed if needed; it was removed during transplantation in the only 3 cases of recent peritonitis. The only complications noted after transplantation were an episode of spontaneously reversible ascites and a peritoneal breach following reintervention on the renal region. This homogeneous series confirms that continuous ambulatory peritoneal dialysis does not constitute a contra-indication, let alone an obstacle, to subsequent renal transplantation. Indeed, it may be regarded as the first-choice method for patients in whom early grafting is envisaged on account of their immune status.

Successful in situ treatment of a fungal peritonitis during CAPD.

A case of candida peritonitis during continuous ambulatory peritoneal dialysis (CAPD) which recovered with intraperitoneal 5-fluorocytosine alone is reported. This seems to be the first case of fungal peritonitis during CAPD without removing the catheter to be described in the literature.

[Removal of the kidney following in situ perfusion]. / Prélèvement de rein après perfusion in situ.

Kidneys of potential donors undergoing sudden cardiac arrest are generally not gathered because the warm ischemia time is too long until nephrectomy. A rapid in situ cold perfusion technique was developed to preserve kidneys in 21 brain-dead patients after cardiac arrest not responding to cardiac resuscitation. In 7 of the 21 potential donors, the in situ perfusion was unsuccessful. In 14 other subjects this technique permitted to save 15 transplantable kidneys; 1 month after grafting, the renal function was similar to that observed in kidneys gathered in living patients. The in situ perfusion technique allows to increase by nearly 10% the efficacy of kidney gathering.