Kidney Transplantations, 1964–66, at Serafimerlasarettet and St. Erik's Hospital, Stockholm

Abstract

This paper is an account of the cases of kidney transplantation undertaken at Serafimerlasarettet and St. Erik's hospital from April 1964 to April 1966. A total of 21 homologous kidney transplantations were made on 20 patients. The donors were 12 relatives, 2 living non-related and 7 cadavers. At the end of the follow-up examination, 11 patients were still alive with observation times of 1/2 to 2 1/2 years. In the 10 cases investigated, the renal function—measured as the creatinine clearance in 24 hours—gave a mean of 54 ml/min.

The transplant was implanted in the pelvis, the vessels being anastomosed to the hypogastric artery and the external iliac vein. The ureter of the transplant was anastomosed to the recipient's urinary bladder (19 cases), ureter or renal pelvis. Urinary fistula developed in the latter cases.

The immuno-suppressive treatment comprised splenectomy (3 cases), drainage of the thoracic duct lymph, cytotoxica and steroids. One case with a state resembling hepatitis was treated for 31 days with steroids alone, while another patient with pulmonary abscesses was treated entirely without steroids for 44 days. The function of the transplant remained unchanged during these peirods.

The immuno-suppressive treatment was accompanied by leukopenia, lymphopenia and thrombocytopenia, which led to a reduction or brief withdrawal of cytotoxica. Other complications which were ascribed to cytotoxica included liver damage (3 cases). Psychosis (1 case) and diabetes (3 cases) were ascribed to the steroid treatment.

Two different forms of rejection were observed, an early one during the first two months, and a late one. The former had a more acute onset and a larger number of findings. The latter was more chronic and had fewer findings. I¹³¹-hippuran renography proved valuable for diagnosing rejection attacks. Rejection was treated by intensifying the immuno-depressive measures mentioned above. In addition, the transplant was irradiated with x-rays.

Various complications are reported for both the donors and the recipients. These included a condition resembling hepatitis in both groups.

The transplant was removed in 4 cases when it ceased to function. A further 6 transplants were obtained at autopsy. These were examined both macro-and microscopically. The kidneys displayed changes of varying degree indicating rejection. The vascular and ureteral anastomoses had healed well.