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Diagnosis of acute rejection (AR) is difficult during acute tubular necrosis (ATN), and a delay of rejection treatment could result in negative impacts on the renal transplant outcome. At our center, 68 cadaveric kidneys were transplanted during the past 7 years. The 1-, 3- and 5-year graft survival rates were 95.4%, 93.8% and 81.4%, respectively. After the transplants, 16 patients had immediate graft function (G-I), 51 patients experienced ATN for 12.0 +/- 9.3 days, and one patient had a non-functioning graft due to diffuse arteriolar thrombosis caused by DIC in the donor. During ATN, 41 patients had no rejection episodes (G-II) and 10 patients had ARs (G-III). Nine patients were treated with bolus steroid and one with steroid and OKT-3. Although scintigraphic and sonographic examinations were routinely employed, only the histopathological findings of needle biopsies were helpful for the diagnosis of AR during ATN. When the transplant outcome was compared, the serum creatinene level was highest in G-III and lowest in G-I (1.48 vs 1.06 mg/dl, p < 0.05). The posttransplant ATN period was also longer in G-III compared to G-II (23.9 vs 9.1 days, p < 0.005). The 5-year graft survival rate was 85.2% in G-I, 88.0% in G-II and 59.3% in G-III. We conclude that routine serial renal biopsies should be scheduled when ATN develops after the cadaveric renal transplant, since only the histopathological diagnosis is reliable during ATN.

When the concept of brain death is not widely accepted, the viability of renal allografts of non-heart-beating cadaveric donors is one of the serious concerns for transplant surgeons. At our center, 200 kidneys were harvested from cardiac arrest donors using the regional in situ cooling technique, and they were transplanted into recipients treated with cyclosporine (CS). The ages of donors ranged from 7 months to 67 years. At the bedside a specially designed double balloon catheter, 14F, was inserted into the aorta through the femoral artery just before or immediately after the cardiac arrest. A venous drainage tube was also placed in the vena cava. Following the cardiac arrest, both balloons of the aortic catheter were inflated, and regional in situ cooling with cold Lactate Ringer's solution started using the infusion pump at 20 mL/kg/min. In the OR, both kidneys were removed en bloc and preserved in Collins'type solution. They were then transplanted into 200 patients treated with CS and steroid. After the transplant operations, 33 patients (16.5%) had immediate renal function, but 14 grafts (7.0%) were not successful and the patients have never had renal function. When several factors such as donor age, warm ischemic time (WIT; 12.3 ± 14.1 minutes), in situ cooling time (IST; 78.1 ± 18.0 minutes) and total ischemic time (TIT; 619 ± 340 minutes) were associated with the post-transplant renal function, only the donor age had significant correlation both with the posttransplant dialysis period and lowest serum creatine level, as follows: 10.5 days ( ≤ 40 years) vs. 14.6 days ( > 40 years); P < 0.05, and 1.16 mg/dL ( ≤ 30 years) vs. 1.83 mg/dL ( > 50 years) P < 0.001, respectively. Our findings indicate; 1) Due to the in situ cooling technique, the renal grafts of non-heart-beating cadavers can be expected to have relatively good function in the CS-treated recipients; 2) donor age is instrumental in predicting post-transplant renal function as well as the duration of ATN; 3) WIT, 1ST and TIT have no association with the post-transplant renal function if the duration of renal ischemia is within the acceptable range.

Vasopressin, a hormone secreted from the posterior lobe of the hypophysis, has endocrinological and antidiuretic effects; it contracts vessels and smooth muscles, especially intestinal smooth muscle. In the present study, we investigated the role of vasopressin (Pitressin: arginine-vasopressin) in elimination of intestinal gas on excretory urography reading. Sixty outpatients were randomly divided into six groups. In Group I, the routine procedure was employed, i.e. laxatives the previous night and NPO the morning of the examination. In Groups II to VI, different dose regimens were employed: 6 or 10 units of Pitressin was administered by subcutaneous injection 30 minutes prior to injection of a contrast medium, with or without NPO. Intestinal gas elimination was evaluated by X-ray films taken before and after injection of Pitressin. The efficacy was rated by four grades. There were no significant differences in the gas elimination or occurrence of side effects between any two groups. Younger patients seemed to respond quickly to Pitressin and good effects were obtained. These results indicate that the pretreatment for excretory urography with 6 units of Pitressin without NPO may be a safe and effective alternative method for elimination of intestinal gas, in particular for young patients.