Abundance of interstitial eosinophils in renal allografts is associated with vascular rejection.

BACKGROUND: The authors investigated the possible relevance of significant interstitial graft eosinophilic infiltrate (SIGEI) to the pathologic diagnosis of renal transplants. METHODS: The authors performed a clinical and pathologic review of 29 consecutive patients with renal allograft failure and nephrectomy. As a result of their size, such specimens are more conducive than biopsies to the investigation of large blood vessels. SIGEI was diagnosed when eosinophils represented 10% or more of the interstitial inflammatory infiltrate. Vascular rejection was graded according to the Banff criteria. Risk for allergic interstitial nephritis and immunosuppression at the time of the nephrectomy-high dose, minimal, or none-was determined from the clinical history. RESULTS: SIGEI was observed in 13 of the 29 patients and was absent in 16. Vascular (Banff type II) rejection was present in 11 of 13 cases with SIGEI and in 9 of 16 cases without SIGEI. The relation between SIGEI and Banff type II rejection was statistically significant: in 14 patients on high-dose immunosuppression, vascular rejection was present in all 5 cases with SIGEI, whereas in the 9 grafts without SIGEI, only 3 had vascular rejection (P=0.04). The authors did not find an association between SIGEI and risk for iatrogenic interstitial nephritis: SIGEI was seen in only 4 of 15 patients with high or moderate iatrogenic risk. CONCLUSIONS: In this series of allograft nephrectomies, SIGEI was significantly associated with vascular rejection (Banff type II) but not with risk of allergic iatrogenic nephritis, suggesting that the presence of SIGEI may be a helpful criterion in the pathologic diagnosis of renal allografts.

Single-center analysis of living donor nephrectomy: hand-assisted laparoscopic, pure laparoscopic, and traditional open.

CONTEXT: Laparoscopic living donor nephrectomy has been shown to be a safe method for removing kidneys for transplantation, but concerns have been raised regarding safety and long-term kidney function. OBJECTIVE: To compare safety and long-term kidney function in hand-assisted laparoscopic, pure laparoscopic, and traditional open living donor nephrectomy. METHOD: The charts of 48 patients with more than 1 year follow-up were reviewed. Thirty-four consecutive patients underwent laparoscopic live donor nephrectomy, and 14 had open donor nephrectomy. All kidneys functioned immediately at transplantation. In the laparoscopic group, 11 had the pure laparoscopic technique, and 23 patients had hand-assisted laparoscopic nephrectomy. RESULTS: Total operative and warm ischemic times were reduced with the hand-assisted technique when compared with pure laparoscopy. Operative and warm ischemic times were similar in open nephrectomy and hand-assisted laparoscopy. Long-term follow-up of serum creatinine levels revealed no significant differences between the 3 groups. Complication rates in the 3 groups were similar. CONCLUSION: Laparoscopic donor nephrectomy appears to be comparable to open donor nephrectomy in terms of safety and long-term graft function.

Metabolic acidosis in the intensive care unit.

Metabolic acidosis is a common occurrence in critically ill patients. Understanding the pathological mechanisms underlying the generation of protons will enable the clinician to quickly recognize these disorders and establish an acceptable treatment strategy. This article presents a logical approach to metabolic acidosis.