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Objective: To evaluate the quality of the postoperative course after conventional organ donation nephrectomy., Patients and Methods: Over the last 29 months, 29 organ donation nephrectomies were performed in our hospital. Thirteen donors were non-residents. This series consisted of twenty organ donations between siblings, two organ donations from children to parents and seven organ donations from parents to children. The mean age of the donors was 42 years (range: 21 to 53). Ten pairs were HLA identical, 18 were semi-identical and one pair had only one A identity in common. The mean plasma creatinine on admission was 81 +/- 23 mumol/l., Results: Twenty three left kidneys and 3 right kidneys were harvested, with the last two right kidneys removed via a right anterior subcostal incision. Among the 23 left lumbotomies, the 11th rib was preserved in 21 cases in order to decrease postoperative pain. The mean operating time for patients operated by lumbotomy was 90 +/- 11 minutes. The mean postoperative stay (MPS) was 4.56 days (range: 3 to 8 days). The mean morphine consumption during hospitalisation was 40 mg per patient (range: 0 to 105 mg). Only one complication was observed: pneumothorax requiring postoperative drainage for 48 hours with no subsequent sequelae. No donor was transfused intraoperatively or postoperatively and no wound sequelae were observed. The mean plasma creatinine on discharge was 113 +/- 23 mumol/l., Conclusion: These results in terms of analgesic consumption, complications, and mean postoperative stay appear to compare favourably with those obtained by other teams, particularly when organ harvesting is performed laparoscopically (MPS: 4.5 days vs 3 days).

Unlabelled: For a long time, retransplanted patients were considered to be high-risk subjects, but a number of studies have shown that retransplantation can give good short-term results., Objectives: Between October 1987 and February 1997, 51 retransplanted patients (Group 1) were compared with 96 patients (Group 2), matched for age, sex and date of transplantation, receiving a first kidney, with a mean age of 41 +/- 10 years and a mean follow-up of 44 +/- 32 months., Results: The patient did not differ in terms of aetiology of the renal disease, mismatches and duration of dialysis before the first transplant and the duration of dialysis before the second transplant was 53 +/- 54 months. In Group 1, transplant loss was due to an immunological [34], surgical [8], or medical [3] cause, or due to recurrence of the disease [3] and discontinuation of treatment [5]. Hyperimmunized subjects were more numerous in Group 1: 21.4% vs 5.2% (p < 0.01). Immunosuppression only differed in terms of Cyclosporin: 65% for Group 1 vs 45% for Group 2 (p < 0.05). The two groups did not differ in terms of acute rejection (33% for Group 1 vs 48% for Group 2), serum creatinine at last review (140 +/- 51 +/- 65 m mol/l) and 5-year and 8-year patient (92 vs 82% and 92 vs 76%) and graft survival curves (85 vs 75% and 59 vs 61%)., Conclusion: This study confirms that retransplantation can be successfully performed, even in terms of long-term results.

Mycophenolate Mofetil (MMF) is a new immunosuppressant demonstrated to be effective at the dose of 2 to 3 g/day. The objective of this study was to determine whether MMF could be used at a lower dose with the same efficacy. Two patient groups were studied: 334 patients treated with azathioprine (AZA) and 60 patients treated MMF (at the dose of 750 mg/day, for patients receiving triple combination therapy or 1.5 g/day for those receiving two-agent combination therapy). The rest of the treatment was identical for the 2 groups. The main endpoint was the incidence of acute rejection at 3 months, which was 16% in the MMF group and 35% in the AZA group (p = 0.003). Multivariate analysis confirmed the impact of the type of purine synthesis inhibitor used (AZA or MMF, p = 0.007) on the acute rejection rate at 3 months. This study confirms the value of MMF, even at doses lower than those recommended in the international literature, with improved safety. MMF has now replaced azathioprine in our immunosuppressant protocols.

Living related donor (LRD) renal transplantation has remained underdeveloped in France up until now. The reduction of the number of available grafts and especially the superiority of the results of LRD transplants recently led us to develop this type of transplantation. We present the retrospective analysis of our experience of 63 cases from March 1973 to June 1995. The actuarial graft survival rate was 91% at 1 year and 87% at 3, 5 and 10 years. The 5- and 10-year survival rates of HLS-identical transplants (n = 17) was 100%. The donor morbidity was minimal (2 cases of parietal suppuration, 1 pulmonary atelectasis). These results emphasize the superiority of LRD transplantation, which also has the advantage of allowing transplantation of hyperimmunized patients in whom the waiting time for a brain-dead donor kidney is long and unpredictable.

Between 1989 and 1995, 32 patients underwent combined kidney-pancreas transplantation for diabetic chronic renal failure. Only one of these patients received an isolated pancreas following cessation of function of a previously implanted segmental pancreas. The surgical technique always consisted of pure retroperitoneal transplantation into the right iliac fossa of a total pancreas transplant with duodenovesical anastomosis. The postoperative complications included one death on D10 from pulmonary vein thrombosis in a patient with sickle cell anaemia and early loss of the transplanted pancreas due to venous thrombosis. Nine patients underwent at least one surgical revision, due to a leaking duodenovesical anastomosis in 8 cases. With a mean follow-up of 33 +/- 20 months, the results demonstrate, apart from the early death indicated above, another death at 50 months of a patient who had lost his pancreas due to early venous thrombosis and who died with a functioning kidney. 23 of the 30 surviving patients have a functioning kidney and pancreas (79%), i.e. 74% of the total population of 32 patients. Loss of pancreatic function was surgical in two cases (one case of infection of the transplant site, one case of thrombosis), vascular in one case due to rupture of a mycotic aneurysm into the duodenum and immunological in three cases: two of these pancreases retained partial function allowing perfect blood glucose control with less than 10 units of ordinary insulin per day. Lastly, a perfectly functioning pancreas was removed 13 months after transplantation because of renal rejection not controlled by reinforced immunosuppression. Compared to the data of the international registry, these results demonstrate the value of the retroperitoneal approach used in this series and the improvement of the results obtained with increasing experience of the transplant team.

From October 1987 to June 1992, 359 renal transplantations were performed, while, over the same period, 25 patients with a follow-up of more than six months underwent repeat renal transplantation: 23 for a second transplant and 2 for a third transplant. The initial disease was glomerular for 17 patients and interstitial for 6 patients. The mean age of the patients at the time of the repeat transplantation was 36.9 years (range: 20 to 53 years). The mean survival after the first transplantation was 3 years and 10 months (range: 1 week to 10 years). The reasons for loss of the first transplant can be classified as follows: acute rejection (n = 5), chronic rejection (n = 14), surgical failure (n = 5) or sepsis (n = 1). 9 patients received conventional immunosuppressant therapy, while 16 patients (64%) received four-drug therapy including cyclosporin. The actuarial one-year survival of the patients and the transplants was 100% and 92%, respectively. The mean serum creatinine was 136.4 +/- 65 mumol/l (range: 59 to 298 mumol/l). Ten patients developed rejection after a mean of 18.6 days (range: 6 to 30 days) and 2 patients suffered from 2 episodes of rejection within 4 months. These results illustrate the low postoperative surgical and immunological complication rate in this group of patients whose long-term results are at least comparable to those of first transplantations in our group.

The authors report the case of a type B EBC (+) primary lymphoma of the bladder occurring in a renal transplant patient 14 months after the graft. The postoperative course had been marked by three episodes of early rejection, the last of which required the use of anti-CD3 antibody, then the later addition of cyclosporin. After immune labelling showing oligoclonal proliferation, the lesion was treated with CD24 and CD21 monoclonal antibodies. Ten months after treatment, the patient is in remission with renal function at 200 mumol plasma creatinine. Azathioprine and cyclosporin have been stopped. This apparently unique case provides the authors with an opportunity to review the usual characteristics of lymphocyte tumours in transplant patients and to stress the rarity of primary lesions of the urinary tract. They conclude that the new therapeutic approach based upon monoclonal antibodies is of value in comparison with the attempts at surgery, radiotherapy and/or chemotherapy used in the past.