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Cyclosporine in whole blood samples from renal and cardiac transplant recipients was measured by high-performance liquid chromatography (HPLC) and by CYCLO-Trac SP specific radioimmunoassay (RIA). The fresh samples assayed by RIA were remeasured in a second laboratory after storage at -20 degrees C for two to six months and good interlaboratory agreement was obtained on the 59 samples assayed (y = 0.926x + 14.8 micrograms/L, r = 0.982). The calibration curve for RIA was not influenced by fresh whole blood, hemolyzed whole blood or serum matrix from normal volunteers. However, comparison of the RIA results from patient samples with those from an HPLC procedure showed that RIA values averaged about double those measured by HPLC. The difference is attributable to differences between the blood matrix of transplant and nontransplant subjects, rather than exclusively to the apparent nonspecific nature of the antibody.

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To examine the specificity of the Incstar Cyclo-Trac SP RIA kit, individual blood samples from 28 cardiac allograft patients on cyclosporine A (CsA) therapy were extracted and chromatographed by HPLC. Initially, eluates from a pool of the above samples were collected at regular intervals and measured by RIA to locate possible cross-reacting compounds. Unknown cross-reacting materials were detected in a fraction (UNK) that was collected before elution of CsA. For each patient's sample, fraction UNK and the fraction containing CsA were then collected and measured by RIA. In 9 of 28 samples, cross-reactivity was detected in fraction UNK; range 11 to 36%, mean 22 +/- 7.5%. Cross-reactivity was not apparent in fraction UNK of CsA-free blood samples from normal volunteers.

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Class II HLA matching, especially HLA-DQ and DR, significantly improved allograft survival. HLA-DQ and DR matching may also be associated, in general, with a quiescent posttransplantation course, reduced incidence of SRRE, and somewhat better response to OKT3 rescue therapy. We conclude that the matching of class II HLA remains an important predictor of transplant outcome in CyA-treated patients and should form the primary basis of organ sharing.

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Although the risk of HBsAg infection has now been reduced significantly by screening of blood, isolation of HBsAg+ patients, and more recently by vaccination, transplant-eligible patients can still be seen. We observed an increased mortality in HBsAg+ patients during 5 to 10 years posttransplantation. However, this could not be attributed to liver disease or dysfunction. Increased mortality and morbidity due to liver disease or dysfunction 10 years posttransplantation suggest that the HBsAg+ patients remain at a higher risk for developing liver disease during that period. In our study, HBsAg+ patients had a 10-year posttransplantation period relatively free of serious liver disease or dysfunction. Furthermore, both HBsAg+ and HBsAg- patients had a similar long-term allograft survival. It is unknown how the use of cyclosporine will affect those survival statistics. We, therefore, believe that HBsAg positivity per se should not constitute an absolute contraindication to transplantation.

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HLA matching at MT and DQ appears to be an important predictor of allograft survival. Allografts with no MM at MT and DQ have a good outcome while a known MM at MT and DQ appears to be associated with poor allograft outcome. Thus, our priority should be to avoid an MM for these broad-reacting specificities and then to minimize incompatibilities at DR and HLA-B. Furthermore, our data indicate that allografts with MM at DQ and two MMs at HLA-B appear to be at a higher risk. Perhaps these latter transplants should not be performed with conventional immunosuppressive therapy.

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Of 149 renal transplants performed between May 1965 and December 1980 a stapled ureteroureterostomy was done in 112 (75 per cent) using a commercially available stapling device. Calculus developed in 7 patients (6.3 per cent) in whom this technique was used, with the interval between transplantation and calculus formation being 13 months to 6 years. We conclude that the stapled ureteroureterostomy should be reserved for special instances, such as a short donor ureter or when the correction of urological complications demands a rapid ureteroureterostomy.

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The authors present the seventh reported case of bilateral renal cell carcinoma in polycystic kidneys. They review the literature on benign and malignant tumours in polycystic kidneys emphasizing the diagnostic problems created by this condition. The diagnosis can be made by renal angiography. Therefore the authors suggest that this procedure should be carried out in all patients with polycystic renal disease who have hematuria.

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One and two-year allograft survival rates of 117 first and 20 second consecutive cadaveric renal allografts are analyzed. The following observations were made: (1) Pretransplant blood transfusions may not improve rate of allograft survival per se. (2) Pretransplant blood transfusions may, however, reduce the number and the severity of rejection episodes in the early posttransplantation period. Thus, the allograft survival, especially in the nontransfused patients, may perhaps be influenced more by the effective manipulation of immunosuppressive therapy during rejection episodes. (3) The presence of lymphocytotoxins per se may not have any deleterious effect on the survival of second allografts.

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The HLA typing of hemodialysis patients and normal subjects suggests a negative association of B8 and positive association of B5 with the development of anti-HBs and a negative association of BW35 with HBsAg antigenemia.

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The normal level of serum or plasma poly C-avid ribonuclease activity is 1047 +/- 247 U/mL. Serum levels increase proportionately with elevations in serum creatinine, reaching levels of 9,500-35,000 in patients undergoing dialysis. The levels can be normalised by successful renal transplantation but not by dialysis. Purified human urinary ribonuclease, a glycoprotein enzyme similar to the serum ribonuclease, was capable of: 1) inhibiting the incorporation of 3H-thymidine into mitogen-stimulated lymphocytes; 2) inhibiting the proliferation and growth of bone marrow red cell colonies; and 3) adversely affecting the growth and viability of precursor fat cells.

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Six cases of acute nonoliguric renal failure following transurethral prostatectomy were studied. This condition usually has a milder clinical course than the oliguric type; but some patients will need dialysis and fatalities can occur. Although it is relatively rare, every urologist shoud be aware of the entity. The first clue is usually increasing azotemia despite a normal or increased urine output.

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Nephrectomy was performed in 12 patients with complete renal artery occlusion and hypertension refractory to intensive medical therapy. Renal vein renin was assayed preoperatively in 10 of the 12, and in 8 the ratio was at least 1.5:1, strongly suggesting renal artery occlusion on the side with the higher concentration of renin in venous blood. In two patients peripheral plasma renin activity was very high before operation, then decreased greatly afterwards. Three patients were considered cured and eight improved (overall improvement rate, 92%). The results were predicted by the renin ratio.

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