Successful kidney transplant from methanol-intoxicated donors.

The well-described disparity between the need for and the supply of organs suitable for transplant is growing. Because of this disparity, mortality of patients listed for transplant is increasing. Donors who die of intoxication (including victims of methanol poisoning) represent less than 1% of suitable donors and might be used to increase the supply of organs. They are often not accepted as donors by transplant specialists, because of concerns about patients' outcomes with these grafts. Three cases of fatal methanol intoxication that resulted in transplants of 6 kidneys are evaluated.

Comparable Renal Function at 6 Months with Tacrolimus Combined with Fixed-Dose Sirolimus or MMF: Results of a Randomized Multicenter Trial in Renal Transplantation.

In a multicenter trial, renal transplant recipients were randomized to tacrolimus with fixed-dose sirolimus (Tac/SRL, N = 318) or tacrolimus with MMF (Tac/MMF, N = 316). Targeted tacrolimus trough levels were lower in the Tac/SRL group after day 14. The primary endpoint was renal function at 6 months using creatinine clearance (Cockcroft-Gault) and was comparable at 66.4 mL/min (SE 1.4) with Tac/SRL and at 65.2mL/min (SE 1.3) with Tac/MMF (completers). Biopsy-confirmed acute rejection was 15.1% (Tac/SRL) and 12.3% (Tac/MMF). In both groups, graft survival was 93% and patient survival was 99.0%. Premature withdrawal due to an adverse event was twice as high in the Tac/SRL group, 15.1% versus 6.3%. Hypercholesterolemia incidence was higher with Tac/SRL (P < .05) while CMV, leukopenia, and diarrhea incidences were higher with Tac/MMF (P < .05). The incidence of any antidiabetic treatment for >30 consecutive days in previously nondiabetic patients was 17.8%, Tac/SRL, and 24.8%, Tac/MMF. Evaluation at 6 months showed comparable renal function using tacrolimus/sirolimus and tacrolimus/MMF regimens.

Discontinuation of mycophenolate mofetil from a tacrolimus-based triple regimen 2 months after renal transplantation: a comparative randomized, multicentre study.

Previous clinical data suggested that with a tacrolimus-based regimen adjunctive immunosuppressives may be withdrawn after an initial treatment period. This study investigated the early discontinuation of mycophenolate mofetil (MMF) from a standard triple regimen. Patients were randomized either to receive a continued tacrolimus/MMF/steroids triple regimen (control group) or to reduce and then stop the MMF dose (MMF stop group). Both groups received identical daily tacrolimus and corticosteroid doses. The initial MMF dose was 1 g/day in both arms, but in the MMF stop group the dose was reduced to 0.5 g/day from week 7 to week 12 and then stopped. The intent-to-treat population consisted of 74 (control) and 78 (MMF stop) patients. MMF was tapered off as planned in 82.9% of the patients in the MMF stop arm. The 6-month incidence of biopsy-proven acute rejection was similar in both arms (21.6% control, 16.7% MMF stop). Graft loss occurred in 5.4% (control) and 3.8% (MMF stop) of the patients. MMF could be safely discontinued from a tacrolimus-based triple therapy early after transplantation without any rebound in efficacy during the 6-month follow-up period. (Name of registry: ClinicalStudyResults.org, number: FG-02-CEE-01, date: 9 June 2006).

The diagnosis of brain death--own experience.

BACKGROUND: The aim of this paper is a description of our experience with scintigraphic detection of brain death. MATERIAL AND METHODS: Thirty-four patients were studied from February 2003 to June 2006. We performed brain scintigraphic examination utilising (99m)Tc-HMPAO and a two-headed SPECT camera E.CAM. We used LEHR collimators. 15% energy window was centred around 140 keV. 650-750 MBq of radiopharmaceutical was injected as a bolus. Then dynamic scintigraphy of the head and neck was done in an anterior projection--2 s per frame for 60 s. Then static scintigraphy of the head in four projections followed (anterior, both lateral and posterior views), for 4 minutes per view. RESULTS: A typical picture of brain death on planar dynamic and static scintigrams showed an absence of perfusion and radiopharmaceutical accumulation in both cereberal and cerebral hemispheres and brain stem. Radioactivity in the area of the scalp and face could be present. Borderline findings, which demanded careful interpretation, were the cases with preservation of minimal cerebral perfusion and simultaneous absence of radiopharmaceutical accumulation in its parenchyma and cutoff of tracer accumulation in cerebral parenchyma only supra or infratentorial. CONCLUSIONS: Cerebral perfusion scintigraphy is the most contributing factor for the diagnosis of brain death in patients after cranial trauma with subsequent neurosurgical operation, when angiography is often unsuitable. In these situations perfusion scintigraphy is able to show the absence of radiopharmaceutical accumulation in cerebral tissue. Scintigraphic detection of brain death gained an important role in new Czech legislation, and the demands of transplant centres for these examinations will certainly grow with the accrual of organ collections.