Immediate and long-term results of ATG induction therapy for delayed graft function compared to conventional therapy for immediate graft function.

The use of polyclonal antibodies for delayed graft function (DGF) was tested in 83 renal allograft recipients. Conventional immunosuppression (CI) was given to 52 patients with immediate graft function (IGF) while 31 patients with DGF received the polyclonal antibody ATG. Administration of OKT3 was restricted to steroid-resistant acute rejections in both groups. The incidence and severity of acute rejections, graft survival rate, CMV infections, and lymphocyte subsets were examined. ATG patients experienced a total of 0.6 acute rejections per patient, whereas CI patients had 0.9 on the average (P < 0.05). Second and third acute rejections occurred less frequently and later in the ATG group than in the CI group (P < 0.01). Steroid-resistant acute rejections occurred in 20 of the CI patients (38 %) but in only 7 of ATG patients (23 %). One-year graft survival in the CI and ATG groups was 98.1% and 93.2%, respectively. A decreased CD4 + to CD8 + T-lymphocyte ratio of about 0.5 was still detectable 5 years after the initial ATG administration. Hence, patients with DGF appear to benefit from induction therapy with ATG.

Pancreas-specific protein (PASP), serum amyloid A (SAA), and neopterin (NEOP) in the diagnosis of rejection after simultaneous pancreas and kidney transplantation.

A reliable, noninvasive indicator of pancreatic allograft rejection is urgently needed. In this study, serum (S), plasma (P), and urine (U) levels of pancreas-specific protein (P-PASP, U-PASP), neopterin (S-NEOP, U-NEOP), amylase (U-AMYL), and amyloid A (SAA) were measured daily in ten type I diabetic patients following simultaneous pancreas and kidney transplantation (SPK). Rejection episodes occurred in three isolated pancreas, nine isolated kidney, and five simultaneous pancreas and kidney transplants. In the case of the eight pancreas rejections, SAA was the rejection marker with the highest diagnostic accuracy (94%). Using P-PASP and U-PASP, an accuracy of 81% and 79%, respectively, was achieved. During viral infections, U-NEOP levels increased to a maximum level of 1904 mumol/mol creatinine, whereas during bacterial infections, SAA levels increased to a maximum value of 43 mg/dl. SAA, measured for the first time in SPK, appears to be a valuable rejection parameter. In combination with U-NEOP and U-AMYL, a differential diagnosis between rejection, bacterial infection, and viral infection was possible. Neither U-PASP nor P-PASP monitoring led to a significant improvement in the results.

Neomycin-induced perception deafness following bladder irrigation in patients with end-stage renal disease.

OBJECTIVE: To report a serious side-effect of intravesical instillations of neomycin in patients with end-stage renal disease. PATIENTS AND METHODS: Three patients (two men and a woman, aged 51.71 and 54 respectively) with end-stage renal disease who had undergone bladder irrigation with neomycin sulphate solution suffered complete irreversible deafness, which was assessed by audiogram. RESULTS: All three patients developed complete perception deafness after 3, 4 and 10 months, with characteristic changes in the audiogram. The severe progressive hearing loss was maximal in the high-frequency range. A high-pitched tinnitus was the first sign of impending hearing difficulty and two patients developed a spontaneous nystagmus. CONCLUSION: In view of the doubtful efficacy and, most importantly, the risk of severe disabling side-effects such as ototoxicity, we recommend the avoidance of intravesical instillation with neomycin whenever possible.

[Differential diagnosis of transplant function disorders in therapy with monoclonal antibodies OKT3]. / Differentialdiagnostik der Transplantatfunktionsstörung unter Therapie mit monoklonalen Antikörpern OKT3.

The use of OKT3 monoclonal antibodies has improved the immunosuppressive therapy. Due to the high efficiency of this treatment there is an increased risk of overimmunosuppression and occurrence of life-threatening viral infections. Therefore a cautious application of OKT3 is mandatory, a reliable differential diagnosis of the deteriorating graft function essential. In this study the high diagnostic value of urinary neopterin in the early and reliable diagnosis of CMV infection under OKT3 therapy in contrast to serum amyloid A as a marker of rejection could be shown. A differential therapy, supporting or reducing the immunosuppression, might be facilitated by daily monitoring of the neopterin and serum amyloid A.

[Experience with uretero-neocystostomy in 338 kidney transplantations]. / Erfahrungen mit der Uretero-Neo-Zystostomie bei 338 Nierentransplantationen.

In 338 consecutive human kidney transplants since 1972 uretero-neocystostomy was performed in a typical manner. The technique is a modification of Leadbetter's ureterosigmoid anastomosis and it is used for all cases of ureteral reimplantation at our institution. The rate of operative complications belonging to the urinary tract is 4.8%. In 29% out of 31 reexamined patients a vesico-ureteral reflux to the transplant appeared. We believe that the demonstrated method is useful for reconstruction of the urinary tract in renal transplants.

[Interventional sonography after kidney transplantation]. / Interventionelle Sonographie nach Nierentransplantation.

In cases of urinary fistulae as well as lymphoceles the only ultrasound-guided percutaneous nephrostomy has led to a good result. In cases of ureterostenosis and distal fistulae the renal function could be preserved by percutaneous nephrostomy. The anterograde pyelography was exact in demonstrating localization of the stenosis which led to a better operative procedure. The interventional ultrasound therefore represents an important option in the treatment of operative complications after kidney transplantation.

[Risks of suprapubic urine drainage using the Cystofix catheter]. / Risiken der suprapubischen Harnableitung mittels Cystofix-Katheter.

In most cases suprapubic urinary diversion preferable to transurethral diversion, primarily because of the minimal risk of infection and avoidance of trauma to the urethra. There are nearly no complications provided careful handling and attention to contraindications. We have had serious complications in a few cases. These observations give us good reason to use an exact punction technique in order not to bring a good method that is otherwise free from complications into discredit.

[Effects of an ultrasonic technic on diagnosis and therapy in urology]. / Auswirkungen der Ultraschall-Technik auf Diagnostik und Therapie in der Urologie.

Sonography today has essentially influenced the diagnostical and therapeutical procedure in urology. Concerning ordinary methods of examination, sonography is not only a superior one, but can give further information. We surely shall get more indications in future. As a method of examination - non-invasive, without danger, always repeatable and sensitive, - sonography fulfills in many cases the qualifications which have to be made to the screening method.

[Combined abnormality of the urinary and genital tract in adults. Case report]. / Kombinierte Missbildung des Harn- und Genitaltraktes im Erwachsenenalter. Falldemonstration.

Starting point of a sepsis with endocarditis which could at last not be controlled chemotherapeutically was a big prostatic utricle cyst. It was hardly accessible for diagnosis, especially X-ray diagnosis. Undoubtedly it is a matter of a rather seldom anomaly although Schuhrke et al. [1] found it in a quarter of their cases with hypospadias. In these cases and especially if a persistent urinary tract infection or a urosepsis exist we have to think of it, as a therapy is possible only operatively.