Tacrolimus Combined with Two Different Dosages of Sirolimus in Kidney Transplantation: Results of a Multicenter Study

Tacrolimus combined with mycophenolate mofetil (MMF) is an effective regimen in kidney transplantation. This study compared the efficacy of combining tacrolimus and two different dosages of sirolimus with an established tacrolimus-MMF regimen. Each day in addition to tacrolimus, 325 patients received 2 mg sirolimus (TAC-SRL2 mg), 325 patients received 0.5 mg sirolimus (TAC-SRL0.5 mg) and 327 patients 1 g MMF (TAC-MMF). The initial tacrolimus dose was 0.2 mg/kg/day. Sirolimus patients received loading doses of 6 or 1.5 mg, and daily doses of 2 or 0.5 mg thereafter. Steroid administration was identical for all groups. The incidence of biopsy-proven acute rejection was lower in the TAC-SRL2 mg group (15.7%) compared with the TAC-SRL0.5 mg (25.2%, p = 0.003) and the TAC-MMF groups (22.3%, p = 0.036). Six-month graft survival was 91.0% (TAC-SRL2 mg), 92.6% (TAC-SRL0.5 mg) and 92.4% (TAC-MMF); the respective values for patient survival were 98.1%, 97.8% and 97.9%. Thirty-four patients (10.5%), 19 patients (5.8%) and 16 patients (4.9%) in the TAC-SRL2 mg, TAC-SRL0.5 mg and TAC-MMF groups, respectively, discontinued the study because of adverse events. Hyperlipemia was reported more often in the TAC-SRL2 mg group (24.0%) compared with 19.4% (TAC-SRL0.5 mg) and 11.0% (TAC-MMF; p < 0.05). Combining 2 mg sirolimus/day with tacrolimus results in lower rates of acute rejection, but a higher incidence of adverse events.     

Pancreas Graft Salvage Using Pancreatico-Duodenectomy With Enteric Drainage

As demand for donor pancreases increases, attempts are being made to utilize even marginal grafts for transplantation. Injury during pancreas recovery can predispose to posttransplant complications and graft loss. Early recognition and correction can salvage these grafts. The authors report an instance of poor segmental perfusion of the pancreas graft that was salvaged by pancreas head resection and enteric drainage through a Roux-en-Y pancreatico-jejunostomy.     

Effects of prostaglandins and the autonomic nervous system on the vasodilatory properties of nitroglycerin in conscious dogs.

This study was designed to assess the respective roles of prostaglandins and the autonomic nervous system in the responses to nitroglycerin (NTG) in conscious dogs. In vivo, NTG (1, 10, and 100 micrograms/kg i.v.) induced dose-dependent decreases in blood pressure and increases in heart rate and cardiac output. Coronary and carotid blood flows increased simultaneously, whereas responses in renal blood flow were biphasic, i.e., an initial decrease was followed by an increase above control at 10 and 100 micrograms/kg. NTG responses were not changed by indomethacin but were affected by chlorisondamine alone or in combination with indomethacin; tachycardia was abolished, and increases in cardiac output after 10 and 100 micrograms/kg were reduced by 26 and 32%, respectively, after ganglionic blockade and by 19 and 32%, respectively, after chlorisondamine plus indomethacin. In addition, increases in carotid blood flow in doses of 100 micrograms/kg were reduced by 88% after chlorisondamine and 83% after chlorisondamine plus indomethacin. Finally, in the presence of chlorisondamine plus indomethacin, NTG induced a more pronounced hypotension associated with a more pronounced renal vasodilation at the highest dose. Independent of indomethacin pretreatment, NTG in vitro induced a dose-dependent relaxation of the carotid, coronary, and renal arteries. Depending on the vascular bed, the reflex and local controls of circulation are affected differently by NTG.     

Hepatic falciform artery

The hepatic falciform artery is an occasional terminal branch of the left or middle hepatic artery, and may provide an uncommon but important collateral route when the principal visceral arteries are occluded.     

Fulminant systemic necrotizing arteritis: CT findings

Fulminant necrotizing arteritis can be a rapidly fatal disease with protean manifestations often suggesting other diagnoses. We present two cases with angiographic and CT correlation and discuss CT findings that are suggestive of the diagnosis.