Organ transplantation at the Rijeka Clinical Medical Center--from kidney to pancreas.

From January 1971 to January 1994 the authors performed 560 kidney, and two simultaneous pancreas and kidney, transplantations at the Rijeka Clinical Medical Center. Three hundred and nine kidneys (55%) were from a related living donor (two from unrelated living donors), while 253 (45%) kidney and two pancreas grafts were from cadaveric donors. Analyzing the mean patients' age at the time of transplantation the authors noticed its steady increase over five-year periods, a decrease of chronic glomerulonephritis from 76% to 60%, and a gradual increase in diabetic nephropathy from 0 to 6%. Cumulative 1- and 5-year patient survival rates after living donor transplants including conventional immunosuppression were 95 and 83%, respectively; with Cs the survival rates were 94% and 90% (N. S.). For living donor kidney grafts the 1- and 5-year survival rates with conventional immunosuppression were 76% and 50%, respectively. With Cs the survival rates were considerably higher: 88% after 1 year and 71% after 5 years (p < 0.01). Cumulative survival rates of patients with cadaveric transplants receiving conventional immunosuppression were 82% and 71%, respectively; with Cs they were 87% and 78% (N.S.). The survival rate of cadaveric transplants was 51% after one year and 38% after five years in the first period, but it improved significantly after introduction of Cs. increasing to 81% and 52%, respectively (p < 0.001). Renal transplantation in diabetics does not preclude the recurrence of diabetic nephropathy in the graft; successful pancreas and kidney transplantation does, however, and thus offers the patient a better quality of life.

[Emergency surgical conditions after kidney transplantation]. / Hitna kirurska stanja nakon transplantacije bubrega.

During the period from 30. 01. 1971 to 30. 03. 1988 403 kidney transplantations were performed on the Surgical clinic KBC and Medical faculty at Rijeka. Satisfactory results were achieved concerning surviving of patients and grafts. Emergency vascular complications leads to lost of graft in most cases. Urologic complications less affecting the graft but because of possible infection could jeopardize the life of patient. In the surgical treatment of urological complications recipient ureter was used in most cases and in two patients isolated ileal loop. Among gastrointestinal complications bleeding from gastroduodenal ulcer was the major problem. After onset of routine use of antagonists of histamine H2 receptors those complications has been reduced from 6.6% to 1.5%. In five patients a spontaneous rupture of graft has happened. In two patients direct suture of rupture saved the graft. All our activities with the patients after kidney transplantation should be in careful treatment and early recognition of complications and aggressive surgical approach when it is necessary.