腎臓移植100例の臨床的観察

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  • 柴垣 昌功
    Department of Artificial Organs and Urology The Cleveland Clinic Foundation Cleveland
  • 中元 覚
    Department of Artificial Organs and Urology The Cleveland Clinic Foundation Cleveland
  • Straffon R. A.
    Department of Artificial Organs and Urology The Cleveland Clinic Foundation Cleveland
  • Kolff W. J.
    Department of Artificial Organs and Urology The Cleveland Clinic Foundation Cleveland

書誌事項

タイトル別名
  • Kidney Homotransplantation.: Clinical Observation of 100 Cases
  • ジンゾウ イショク 100レイ ノ リンショウテキ カンサツ

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Between January 1963 and December 1965, 100 cases of renal homotransplantations (25 from living donors and 75 from cadavers) were performed on 84 patients with terminal renal failure at The Cleveland Clinic Foundation. In 84 recipient, 53 are still living and three of them have been living over two years, 17 over one year (three of 53 are now back on periodic hemodialysis). In 25 transplants from living donors, 15 have still be functioning and 3 of which are now over two years, two over one year. In 75 cadaver homografts, 35 are functioning, ten of which are now over one year. In general, live donor homografts begin to show diuresis within a few hours after transplantation, and for cadaver kidneys, oliguric period of from several days to a few weeks preceded the onset of diuresis. Thereafter, uremic symptoms subside or are eliminated, havipg a majority of recipients be liberated from diet restriction and resume their active and useful lives. Large dosis of azathioprine and steroid were used as the major immunosuppressive drugs. When the evidences for possible rejection, such as fever, oligulia, azotemia or hypertension were noticed, either resumption of large dosis of steroid, actinomycin-c or local Jrradiation of Cobalt were employed to suppress rejection crisis. Failure of homografts, when developed, usually were seen within the first three months. Postoperative complications (homograft infarction, necrosis or stricture of ureter, disruption of renal artery anastomosis etc.) were the commonest cause of failure and rejection or infection were the second. We failed to find an unequivocal evidence for the correlation between rejection and either ischemic time or ABO blood type crossing. Possible relation of blood type crossing with homograft infarction was suggested. Isotope scanning and/or angiogram of transplant often provided the useful adjuncts for diagnosis of post-transplantation renal failure. Infection was the major cause for recipient's ceath (58). We have experienced two Berths of fluminent necrotizing hepatitis and two other cases who died of symptoms similar to "Wiskott-Aldrich. Syndrome ", on whom cytomegalic inclusion bodies were found at autopsy. We were impressed withh severe leucopenia in some of the infected patients who followed fluminent fatal course. We were encouraged by the good result oI cadaver homotransplation and emphasized the important role of hemodialysis in renal tracsplantation. Developement of the proper methode for anticipation of immunological compatibility and the so-called "kidney bank" were desired.

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