Exchange of Cadaveric Kidneys for Transplantation in Australia and New Zealand*

Summary: In the period from March 1970 to April 1978, 176 kidneys from 137 cadaver donors were exchanged, on the basis of HLA matching, between transplant centres throughout Australia and New Zealand. The kidneys were preserved by simple ice storage or machine perfusion, and transported by air in chipped ice. Total ischaemia times ranged from 3·5 to 28·6 hours and immediate function occurred in 52% of cases. Graft survival was 62% at one year, 51% at three years and 47% at five years, the corresponding patient survival rates being 86%, 74% and 71%. An average of 1·4 antigens mismatched was achieved, and 59% of recipients received kidneys with zero or one antigen mismatched. These kidneys survived better than those with two or more antigens mismatched, the difference being 12% at one year, and rising to more than 20% at five years. The results confirm the practicability and potential value of the Organ Sharing Scheme, and indicate that effective sharing of kidneys on the basis of zero HLA mismatches could substantially improve the current success rate of clinical cadaveric renal transplantation.     

Quinine dermatitis: Investigation of a factory outbreak

An outbreak of dermatitis is reported in process workers in a factory manufacturing quinine. Patch testing suggests that the main problem is a primary irritant contact dermatitis.     

Comparison of three immunosuppressive regimens in cadaver renal transplantation: long-term cyclosporine, short-term cyclosporine followed by azathioprine and prednisolone, and azathioprine and prednisolone without cyclosporine

We conducted a randomized trial in seven Australian hospitals of the efficacy and safety of three immunosuppressive regimens after first transplantation of a cadaver kidney: long-term cyclosporine, short-term (three months) cyclosporine followed by azathioprine and prednisolone, and azathioprine and prednisolone without cyclosporine. Patients assigned to long-term cyclosporine (n = 138) or short-term cyclosporine followed by azathioprine and prednisolone (n = 141) had similar actuarial 12-month survival (98.4 vs. 96.4 percent) and graft survival (83.9 vs. 82.1 percent). Patients assigned to receive only azathioprine and prednisolone (n = 138), with optional use of antithymocyte globulin, had a significantly poorer survival rate (91.3 percent, P = 0.015) because of deaths from cardiac causes and infection, but their graft survival of 76.0 percent (P = 0.31) did not differ significantly from that of either group receiving cyclosporine. After the switch from cyclosporine to azathioprine and prednisolone, 15 percent of patients had reversible rejection episodes, but the frequency of rejection and graft loss did not differ from that in the long-term cyclosporine group. After the change to azathioprine and prednisolone, serum creatinine levels declined in nearly all patients, so that after three months they were comparable to those in the group receiving azathioprine and prednisolone only, and significantly lower than those in the group receiving long-term cyclosporine therapy (P less than 0.003). We conclude that the two cyclosporine regimens result in comparable patient and graft survival, but that changing to azathioprine and prednisolone at three months improves graft function.     

The evaluation of a new technique for anaerobic sampling of deep periodontal pockets

A new technique for the anaerobic sampling of deep periodontal pockets has been developed and evaluated in vitro and in vivo. The mean percentage difference of total viable counts from pairs of samples from nine deep periodontal pockets was found to be 76.4%. This compared favorably with an established technique for which the equivalent figure was 147.4%. Evidence was obtained that the first sample taken with the new sampler depleted the site. When correction was made for that effect, the mean percentage difference was found to be 31.1%. That value was in good agreement with the variation obtained by taking repeat samples from centrifuged deposits of pure cultures of bacteria.     

Oral microbiology: current concepts in the microbiology of dental caries and periodontal disease.

The microbial flora of the mouth is highly complex, containing a wide variety of bacterial species. The most common types of oral disease, dental caries and periodontal disease, are both related to dental plaque and seem to occur when the normal balance between the microorganisms and the host is disturbed in some way. Dental caries is usually associated with increased numbers of mutans streptococci and lactobacilli at the sites of disease; estimation of salivary levels of these organisms may be useful for assessing caries risk in patients and for monitoring their response to preventive measures. A large number of 'candidate pathogens' have been identified as potential aetiological agents in different types of periodontal disease, although the 'specific plaque hypothesis' may still be controversial. Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, together with the poorly understood spirochaetes, have most frequently been reported as significant periodontopathogens and a number of possible virulence factors have been described. Application of modern molecular techniques to the study of the microbiology of oral diseases should allow rapid further progress to be made and will lead, hopefully, to improved methods of diagnosis, risk assessment and treatment.     

A numerical taxonomic study of the "Streptococcus milleri" group based upon conventional phenotypic tests and pyrolysis mass spectrometry.

Clinical strains presumptively identified as Streptococcus milleri (60), and blind coded collection strains (21) were characterised in conventional tests and pyrolysis mass spectrometry. Comparison of the clusters found by these two approaches revealed five clearly distinct centres of variation. Three corresponded to the DNA homology groups suggested by Whiley and Hardie (1989) as representing the species S. anginosus, S. intermedius and S. constellatus; a fourth comprised three Lancefield group C beta-haemolytic strains; the fifth may represent a biotype of S. anginosus. The characteristics of the latter group are described.