We report on the successful regrafting of a transplanted liver. The donor liver was first grafted into a patient suffering from cryptogenic cirrhosis; the patient died 1 day after the elective transplantation of cerebral bleeding. The well-functioning graft was harvested again and transferred to our institution. After another 12 h of cold ischemia, the liver was reperfused in an urgently registered patient with recurrence of hepatitis B in his first graft. The transplantation was successfully performed and the patient is now doing well, more than 5 months after regrafting with the reused liver.

In a retrospective study of 814 patients (349 women, 465 men) who had received their first kidney transplant, early function rate as well as transplant and patient survival rates were determined in relation to age (up to 50 years: 530; 51-55 years: 140; 56-60 years: 83; over 60 years: 61). The same rates were also grouped by donor age (> 16 years, 68 patients; 16-40 years, 387; 41-50 years, 165; 51-60 years, 144; over 60 years, 50). The 5-year transplant function rate fell significantly with increasing donor age (P = 0.0001) from 78% (16-40 years) to 47% (over 60 years). For the same age groups the proportion of transplants which never resumed their function rose from 8 to 28%. Age of recipient had no influence on early function and 5-year transplant function rates. Thus, regardless of the recipient's age, higher donor age is an independent risk factor for early and late results after transplantation.

Tacrolimus has been effective both in primary and rescue therapy following steroid and OKT3-resistant acute rejection in liver and kidney transplantation. Due to the effects of tacrolimus on glucose metabolism, there has been concern about its use in simultaneous pancreas/kidney transplantation. We report on the results of six patients (three female, three male, age 35.2 +/- 7.3 years) converted from cyclosporin A to tacrolimus following simultaneous pancreas/kidney transplantation in steroid-resistant acute rejection. Tacrolimus was induced 2.8 +/- 1.7 months (range 1-4.8 months) after transplantation; follow-up was 3-18 months. Following conversion, creatinine levels declined in all patients [3.5 +/- 1.2 mg/dl before conversion, 3.0 +/- 1.9 mg/dl (n = 6) at three months, 1.4 +/- 0.1 mg/ dl at 1 year (n = 3)]. Before conversion, fasting blood glucose levels averaged 154 +/- 33 mg/dl, with three patients receiving insulin. Three months later no patient required insulin, the mean glucose level being 107 +/- 23 mg/dl (n = 6); at 1 year it was 92 +/- 9 mg/dl (n = 3). One patient lost his pancreatic graft after 4 months due to a mycotic aneurysm. We conclude that conversion to tacrolimus is a safe and effective treatment in cases of steroid-resistant rejections following pancreas/ kidney transplantation.

No abstract