The first 100 kidney transplants from living related donors at Groote Schuur Hospital.

Improved results with cadaver kidney transplantation and the increase in the number of cadaver organs have caused the continued use of donor kidneys from living relatives to be questioned. In this analysis of our first 100 renal transplants involving a living related donor, the 5-year graft survival rate was 70%. The 5-year graft survival rate for recipients of grafts from HLA-identical donors was 81%, as opposed to the 64% survival rate for grafts from one-haplotype donors. Recipients of grafts from one-haplotype-matched donors who received donor-specific blood transfusions demonstrated better graft survival than those who were not transfused. This analysis demonstrates that the results of living related kidney transplantation are good, and suggests that donor-specific blood transfusions may be beneficial.

Protective effect of vasodilators in donors requiring pressor support.

Renal dose dopamine given to organ donors improves renal blood flow and therefore should theoretically improve the quality of the renal grafts and increase the incidence of immediate graft function (IGF). Allografts which function immediately have a better long-term survival. Dopamine, in doses of less than 4 microg/kg per min, acts directly on receptors in blood vessel walls in the splanchnic bed causing vasodilation. In contrast, dopamine given at doses of greater than 4 microg/kg per min to hypotensive donors to elevate the systemic blood pressure has a direct adrenergic effect and causes vasoconstriction. This vasoconstriction when combined with the reperfusion injury which occurs after transplantation may jeopardize the chance of the graft functioning immediately. We studied 31 consecutive donors to see if those donors requiring pressor support (dopamine) to maintain systemic blood pressure had a lower incidence of IGF and whether this could be modified by giving the donor vasodilator drugs during procurement of the organs.

Demographic factors influencing consent for cadaver organ donation.

The records of all donor referrals to Groote Schuur Hospital over a 5 1/2-year period were retrospectively examined to determine which factors influenced the families' decision on organ donation. In 35% of these referrals the families were not approached for consent. The reasons for this included the potential donor being unsuitable for organ donation or not meeting all the criteria for brain death. The effects of the age, sex, race and the cause of death of the potential donor on whether the family gave consent were investigated. This study demonstrates that consent was given more readily when the potential donor was aged less than or equal to 10 years, that the sex of the potential donor appeared to have no effect on the decision by the family about organ donation, that black families gave consent for organ donation less frequently than families of other race groups and that consent was obtained more easily when death was due to suicide.

Conversion from cyclosporin to azathioprine 3 months after renal transplantation--is it safe?

In 26 renal allograft recipients treated with low-dose steroids and cyclosporin A (CyA) the CyA was withdrawn after 3 months and azathioprine substituted. Seventeen patients (65%) had no rejection episodes after stopping CyA (mean follow-up of 13 months). Only 2 patients (7.7%) developed acute rejection episodes in the first month after withdrawal of CyA. In 1 the rejection was easily reversed with intravenous methylprednisolone but in the other CyA had to be reintroduced; graft function then improved. Despite the very low dose of CyA used, a comparison of the mean plasma levels of urea and creatinine in the month before and after stopping CyA revealed a significant fall (P less than 0.001). The findings suggest that this policy is safe and avoids the potential hazards of long-term CyA.

Renal transplantation in primary reflux nephropathy without nephro-ureterectomy. A report of 4 cases.

If there is no evidence of infection in end-stage renal failure secondary to primary reflux nephropathy, renal transplantation can safely be performed without prior nephro-ureterectomy. Four cases are described in which reimplantation of the ureters was performed before or at transplantation. This procedure will cure reflux and maintain the integrity of the renal parenchyma and ureters.

The influence of cyclosporin on graft and patient survival after renal transplantation. The Groote Schuur Hospital experience.

Fifty pretransfused patients received kidney allografts from brain-dead donors. Cyclosporin was combined with low-dose steroid administration for immunosuppression. Three months after transplantation azathioprine was substituted for the cyclosporin. Patient and graft survival rates were 94% and 88% respectively, with a mean follow-up period of 8 months (range 1-15 months). HLA A, B, C and DR antigens were not considered in the selection of recipients. The ease of use of cyclosporin and its infrequent side-effects are discussed.

Medical, legal and administrative aspects of cadaveric organ donation in the RSA.

A shortage of donors remains the major limiting factor as regards the number of kidney and heart transplants performed in South Africa each year. The medical, legal and administrative aspects of cadaveric organ donation in this country are reviewed. The pathophysiology of brain death and the criteria necessary for a definite diagnosis are described, together with the criteria for the selection of cadaveric organ donors. The statutory requirements pertaining to the removal of human hearts and kidneys for the purposes of transplantation are detailed. The subsequent management of the brain-dead donor up to the time of excision of the required organ is described, and a note regarding the preservation and transportation of the donor organs is added.

Prevalence of eggs of Baylisascaris procyonis (Nematoda:Ascaroidea) in raccoon scats from an urban and a rural community.

Twenty-six of 97 (27%) scats from raccoons (Procyon lotor) in an urban area and 37 of 121 (31%) scats from raccoons collected in a rural area of Indiana during October and November of 1980 contained eggs of Baylisascaris procyonis, an ascarid of animal health significance. Raccoons that were livetrapped from the same areas had similar prevalences of B. procyonis eggs in their feces. Therefore, monitoring the prevalence of B. procyonis in raccoon populations by analyzing scats appeared to be feasible.

De novo malignant tumours in renal transplant recipients.

Malignant tumours developed in 8 of the 209 patients who received renal transplants at Groote Schuur Hospital, Cape Town, between October 1967 and December 1979. One of these patients developed disseminated carcinoma of the breast, a disease which had been present in the donor. He was therefore excluded from the study. At 3,4% the incidence of de novo malignant tumours in transplant recipients is half that previously reported in South Africa. No case of reticulum cell sarcoma or intracranial lymphoma was found.

Measles vaccine efficacy: influence of age at vaccination vs. duration of time since vaccination.

To evaluate the recent decision of the Advisory Committee on Immunization Practice to increase the recommended age for initial measles vaccination from 12 to 15 months, we carried out a case control study of vaccine failure in a recent measles epidemic. Compared to children vaccinated at ages 15 months or older, we found an increased risk of vaccine failure among those vaccinated at 12 to 14 months (relative risk = 19.2, 95% confidence interval = 4.6 to 80.1). In order to sort out the influence of age at vaccination from elapsed time since vaccination, we subjected the data to discriminant analysis. Age at vaccination subsumed all of the effect of duration of time since vaccination. Thus, we find no evidence of waning immunity over time.

Femoral neuropathy after renal transplantation.

Two cases of postoperative femoral neuropathy have been encountered in 135 renal transplant patients operated upon at Groote Schuur Hospital since 1967. It is thought that the lesions were due to anoxia secondary to compression of the nerve by a self-retaining retractor blade. Electromyographic studies were useful in assessing the severity and prognosis of the lesion. A prolonged convalescence may occur with a varying degree of residual neurological deficit.

Fluid collections associated with renal allografts.

In a series of 50 consecutive renal allograft patients, 4 developed lymphoceles and 1 developed a seroma which later became infected. In no instance could the fluid collection be held responsible for deterioration in graft function. Two of the lymphoceles occurred with ureteric strictures and perirenal abscess was associated with acute rejection. The significance of a perirenal collection with deteriorating renal function is discussed.

Ureteric obstruction in renal allograft recipients.

In 50 consecutive renal allograft recipients, operated upon between September 1975 and March 1977, we have encountered 10 cases of ureteric obstruction. The patients fell into two groups: those with ureteric obstruction of early onset due to intraluminal blood clot, oedema of the distal end of the ureter, ureteric tip necrosis or extrinsic compression by the spermatic cord, and those with obstruction of late onset due to ureteric fibrosis. Two cases of ureteric obstruction due to oedema and 1 due to intraluminal blood clot resolved spontaneously. Transurethral ureteric meatotomy, a recommended procedure for the relief of ureteric obstruction in suitable cases, was successful in 1 of our patients. The remaining 6 patients required open surgical procedures for relief of obstruction. In no instance did ureteric obstruction result in death or graft failure.