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Objective: The aim of this study was to characterize patient antibodies before and after cadaver and/or living-donor kidney transplantation and to correlate these data with the clinical course after transplantation., Methods: Sera from 69 cadaver, 9 living-related and 2 patients waiting for living-donor kidney transplantation were analyzed by the complement dependent cytotoxicity (CDC) test, flow cytometry (FCXM) and ELISA., Results: FCXM revealed that 15.0% of patients before transplantation and 16.7% after transplantation had antibodies to donor cells. 10.3% patients were positive before and after transplantation (+/+), while 6.8% developed antibodies early after transplantation (-/+). Analysis of the specificity of those antibodies by ELISA showed that it was directed to: 1) mismatched donor HLA antigens 2) antigens belonging to the same cross-reacting group (CREG) as the mismatched donor antigens 3) HLA antigens not expressed by donor cells or, probably, to non-HLA antigens., Conclusion: Anti-HLA antibodies were detected in patients before and after transplantation and in most cases their anti-HLA specificity could be determined. Fast and precise characterization of antibodies in patients before and after transplantation can be performed by both sensitive methods--FCXM and ELISA--which may help predict the onset of immunological complications and, consequently, improve the prognosis after organ transplantation.

In the period 1966-1997 renal allografting was performed in 1746 recipients, 244 of whom were women in fertile age. In 32 of them 45 pregnancies were registered. 29 of them (64%) resulted in abortion, which was spontaneous in 4 and medically advised in 25. There were 16 labours, 4 of them free of any complications; of the latter, hypertension was the most frequent one (8). Of the former, 13 were solved by caesarean section and 3 were vaginal deliveries. Of 15 live babies 7 were immature (one died 1.5 year later of renal failure due to microcystic kidneys). No unfavourable effect of pregnancy on prognosis and on long-term graft function was found.

In a group of patients after transplantation of the kidney with stabilized graft function treated by Consupren sol. combined with prednisone and azathioprin in 20 patients (group A) Consupren sol. was replaced by Consupren S capsules, in 17 patients (group B) Consupren sol. therapy proceeded without any change. To maintain the cyclosporin blood concentration within the therapeutic range it was necessary after the change of drug form in group A to adjust the dosage of the drug in 12 patients of group A while in group B only in one patient (p<0.01). The mean doses and levels of Cy-A however did not change significantly during the three-month investigation period in the two groups and and the bioequivalence of the two preparations was evident. Conversion from Consupren sol. to Consupren S capsules is not associated with the risk of rejection or undesirable effects. It can be implemented at a ratio of 1:1 or 1: the closest dose divisible by 25 (the smallest capsules are 25 mg) and after conversion a check-up or possible modification of the dose is necessary.

The authors compared in a controlled clinical study two groups of patients after a first renal transplantation treated by triple drug immunosuppressive therapy. In a group of 31 patients the triple combination comprised Sandimmune Neoral. In the control group there were 30 patients who received Sandimmune. No differences were found between the two groups as regards the effectiveness of this treatment and the authors did not confirm a lower incidence of rejections described in patients treated with Sandimmune Neoral. They confirmed, however, a lower interindividual variability of Cy-A levels assessed specifically in patients treated with Sandimmune Neoral.

Twenty women with asymptomatic significant bacteriuria took Trimethoprim (TMP) VUFB, 2 X 200 mg, for eight days. Twelve had morphological changes of the urinary pathways confirmed by intravenous pyelography. The test for the presence of bacteria with an antibody film in the urinary sediment suggested that the infection was in the upper urinary pathways in eight of the women. Immediately after termination of treatment the urine was negative in 16 women (80%), after another three weeks the negative finding persisted in the urine of nine women (45%). In one patient treatment was discontinued after five days on account of dyspeptic complaints, the remaining patients tolerated the drug well.

In 26 patients with different clinical forms of infections of the urinary pathways a 300 mg single dose of netilmicin was administered by the i.m. route and the bacteriological urinary finding was checked for as long as 10 weeks after administration of netilmicin. During this period the urine was bacteriologically negative in 42% of the subjects. In 8 subjects with relapses of the infection a second dose of 300 mg netilmicin was administered and the urine was bacteriologically negative for 10 weeks in four of the patients. On the whole it proved possible to eliminate the urinary infection for 42-112 days in 17 subjects (65%), even in so-called complicated infections. It may be stated that single dose treatment with netilmicin used once or repeatedly leads to prolonged elimination of the infection without affecting the sensitivity of the organisms, without side-effects and with a substantial reduction of the cost of treatment.

Fifty-four patients with complicated UTI were administered ciprofloxacin in doses of 500 mg (30 subjects) and 250 mg (24 subjects) at 12-hour intervals. While a positive effect was noted in 96-100% upon termination of therapy, the effect was still present 3 weeks later in 90% of the high-dose, but only in 71% of the low-dose group. In 23 patients with uncomplicated UTI, a positive effect of the three-day therapy with 100 mg of ciprofloxacin at 12-hour intervals was observed in 91% of subjects. Intolerance to the agent was found in one case only. Development of resistance to ciprofloxacin was not observed.

The administration of Solco Urovac polymicrobial vaccine to 26 patients with recurrent episodes of urinary tract infection significantly reduced the number of episodes, in one third of the persons even prevented them for a period of one year. In case of persistent bacteriuria, accompanying, for example, nephrolithiasis, the vaccine had no effect. A better effect can be achieved in cases of uncomplicated infections of the lower urinary tract than in infections associated with structural abnormalities of the kidneys and urinary tract. In some patients, the administration of the vaccine is accompanied by mild side effects which, but only exceptionally, can lead to the discontinuation of the therapy.

A retrospective study in 20 seronegative and 61 seropositive (complement fixation) first cadaver donor graft recipients brought evidence that in cytomegaly, not the infection alone, but curtailment of azathioprine shortly after transplantation (or summation of both) may result in rejection and impaired graft survival. Preliminary data (accumulation of 125I-labelled fibrinogen in two and morphology of the graft in two other patients) showed that depression of graft function in cytomegaly is not necessarily due to rejection.

The paper deals with the incidence of infectious complications and rejection crises in patients with renal transplants. It was revealed by statistical methods that there exists a certain correlation between infections and rejections, which depends on the type of the infectious agent. In patients where infectious complications were caused only by gram-negative flora an indirect relationship was revealed, while in patients with infectious complications where gram-positive flora, viruses or fungi participated, a marked direct correlation was found. Statistical methods proved also a higher incidence of rejection crises in patients with active cytomegalic infection.

Using the radioisotope method, we examined the residual bladder volume in 30 persons without kidney and urinary tract disease, 71 patients with recurrent urinary tract infections and 56 renal transplant patients. The results showed significantly higher bladder volumes in patients with urinary tract infection than in transplant patients without urinary tract infection, non-transplant patients with urinary tract infections and subjects without urinary tract disease. Increased residual bladder volume, which is a manifestation of disturbed bladder evacuating capacity, is not related to age, the length of the postoperative period, the presence of vesicoureteral reflux, or the pretransplantation level of diuresis. The results suggest that the major factor responsible for the disturbed evacuating capacity is the degree of bladder wall injury sustained on neo-ureteral implantation. Functional disturbances render the bladder prone to bacterial invasion of the lower urinary tract and recurrent urinary tract infection.

A group of 44 patients with various clinical forms of urinary tract infections received a single dose of 300 mg netilmicin i.m. The treatment was efficacious in all patients with infections which were negative in the antibody-coated bacteria test and not complicated by anatomic and/or functional abnormalities of the kidneys and urinary tract. After three weeks the recurrence rate was only 19%. Single-dose treatment also proved very effective against urinary tract infections in renal transplant patients whose infection is almost always located in the lower urinary tract. In contrast, the short-term results of treatment were much poorer in complicated infections and particularly in urinary tract infections which were positive in the anti-body-coated bacteria test; here, the recurrence rate was 67%.

The incidence of urinary tract infections (UTI) in 299 renal graft transplantations (281 patients) was analyzed. UTI episodes were demonstrated in 185 grafts (62%), most frequently in the first month after transplantation. The infectious episodes were mostly recurrent. Persistent infection, detected in 11% of grafts, was associated with urologic complications in almost all cases. No significant correlation between the primary renal disease and the UTI rate was found, and there was no significant correlation between UTI and sex. In grafts with recurrent infectious episodes, vesicoureteral reflux was more common. No significant difference was observed in the residual bladder volume, irrespective of whether infection was present or not. The urine was infected by a number of hospital strains, particularly Klebsiella, Enterobacter and indole-positive Proteus strains. An overwhelming majority of UTI episodes (96%) were asymptomatic. Antibody-coated bacteria in urinary sediment were present in only 19% of infectious episodes. Clinically severe courses were observed in infections associated with urologic complications (especially urinary fistulae); these were difficult to treat and were often a source of sepsis and a risk factor in graft loss.