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A 76-year-old female patient complained of progressive episodes of chest and left arm pain and numbness, accompanied by a burning sensation in the left breast. The symptoms were nitroglycerine-responsive and consistent with her prior angina. Cardiac history included an initial percutaneous coronary intervention and 4 subsequent occurrences of restenosis in a stented area of the left anterior descending (LAD) coronary artery. Following a fifth restenosis of the LAD, the Novoste Beta-Cath Brachytherapy System was employed following balloon dilatation of the persistent recurrence. At 10 months post-brachytherapy, angiography revealed a patent LAD with no evidence of in-stent restenosis.

Purpose: With improved chemical immunosuppressive agents, approximately 90% of rejection episodes can be reversed. However, in situations of failed immunosuppression, graft loss becomes inevitable. Our objective is to assess the efficacy of local graft irradiation (LGI) as an effort of last resort in a contemporary group of patients in whom graft failure to irreversible cellular and vascular rejection is imminent., Methods and Materials: A total of 308 renal transplantations were performed at our institution from 1992 to 1995, and an overall 1-year graft survival rate of 90% has been seen as a result of improvement in chemical immunosuppression. However, 6 patients were referred for LGI when all other measures failed to reverse the rejection crisis. Parameters that were studied in these patients included graft function and postirradiation graft histology., Results: Irradiation was associated with reversal of the rejection crisis and resulted in documented histological long-term graft survival in 1 of the 6 patients (17%). Two of the six patients (33%) had reversal of the rejection episode based on postirradiation biopsy of the renal allograft. Three of the six patients showed some level of clinical improvement of graft function for varying periods of time. One patient maintained stable allograft function without deterioration and with continued independence from hemodialysis. One recipient died from sepsis despite histologic improvement after irradiation., Conclusions: Our impression is that LGI is indicated when all other measures have failed to reverse an acute rejection episode in the transplanted renal allograft. The role of radiation in this setting should be studied further.