No abstract

Short term enlimomab induction therapy after renal transplantation did not reduce the rate of acute rejection or DGF.

Ion pumping by the erythrocyte Na, K-ATPase has been measured using ouabain-sensitive ⁸⁶Rb flux in 11 non-dialysed patients with chronic renal failure (CRF), 13 patients on haemodialysis (HD), 13 patients on peritoneal dialysis (CAPD) and 15 patients with functional transplants (FT). Flux measurements were performed in plasma and simultaneous estimates of specific ³H-ouabain binding were made. The results indicate that, compared to normal controls, NaK pump flux was reduced by 21% in CRF (p < 0.01), 30% in HD (p < 0.01), 15% in CAPD (p < 0.02), and was normal in FT. Mean specific ouabain binding sites per cell ( ± SEM) were; controls 366 ± 16; CRF, 290 ± 16; HD, 344 ± 17; CAPD, 321 ± 18; FT, 345 ± 26. Calculation of mean turnover rate per pump site indicated that patients on HD showed a 30% reduction compared to controls (influx 55 K ions/s versus 79 K ions/s, p < 0.01). Cross-incubation experiments suggest that the lowered pump flux seen in the CRF and HD groups was due to plasma factors. This work shows that erythrocyte NaK pump number is reduced in CRF, while patients on maintenance HD have normal pump numbers per erythrocyte but reduced pump turnover.

SUMMARYPatients with chronic renal failure undergoing renal transplantation have a high prevalence of cardiovascular disease. Invasive investigation may identify those at risk of cardiac death during or after renal transplantation, but which patients should undergo cardiac catheterization is currently not clear. In 95 patients awaiting renal transplantation we assessed the ability of echocardiography and exercise electrocardiography to identify patients at risk of cardiac death.Echocardiography identified impaired left ventricular (LV) systolic function in 20%, severe in 8%. Of the patients with severe LV dysfunction, 25% died before transplantation. Of those undergoing exercise electrocardiography, 44% did not achieve 85% of maximum predicted heart rate. No coronary artery disease requiring intervention was identified by exercise testing.These findings indicate that echocardiography, but not exercise electrocardiography, should be part of the assessment for renal transplantation.

We report a successful renal transplant in a highly sensitised paediatric recipient following removal of HLA-specific antibodies by extracorporeal immunoadsorption. The immediate pretransplant cytotoxic titre against the donor was greater than 1:512; this was reduced to negativity by two immunoadsorption sessions prior to transplant surgery. We also describe the presence of unexpected non-HLA-specific antibody activities in this immunoadsorbed patient.