Research reports in the medical literature in July focused on the ability of pancreas transplantation to reverse diabetic nephropathy, the high risk of significant morbidity decades after kidney transplantation, and the identification of simian retroviruses in two human recipients of baboon livers.
"Pancreas transplantation can reverse the lesions of diabetic nephropathy, but reversal requires more than five years of normoglycemia," Paola Fioretto, MD, PhD, and colleagues at the University of Padua in Italy and at the University of Minnesota reported in The New England Journal of Medicine (1998;339:69-75). The researchers studied kidney function in eight patients with type 1 diabetes who had lesions of diabetic nephropathy at the time of pancreas transplantation. Although the patients still showed signs of kidney disease five years after transplantation, the lesions of diabetic nephropathy were ameliorated after ten years of normoglycemia. The researchers said that the beneficial effects of pancreas transplantation "must be considered along with the nephrotoxic effects of some current immunosuppressive agents, especially cyclosporine, the risks of surgery, and the adverse consequences of lifelong immunosuppression."
Investigators at the University of Cincinnati Medical Center reported in July in the American Journal of Kidney Diseases (1998;32:101-106) that long-term survivors of kidney transplants are at risk for significant morbidity even in the third decade after transplantation. V. Ram Peddi, MD, and colleagues followed 43 patients who had had a kidney transplant 19 to 29 years before. Eight grafts were lost--five with the death of the patient, one to glomerulosclerosis, and two to chronic rejection 22 and 25 years after transplantation. Despite the risk of morbidity, the researchers said that "transplantation, even in its earliest years and despite the numerous complications, has provided 19 or more years of near-normal life to 43 patients who otherwise would have been dialysis-dependent."
Dr. Jonathan Allan, of the Southwest Foundation for Biomedical Research in San Antonio, and coauthors reported in AIDS Research and Human Retroviruses (1998;14:821-824) that simian retroviruses have been detected in the tissues of two men who died 27 and 70 days after receiving baboon liver transplants in 1992 and 1993. Both patients had endstage hepatic disease that was associated with hepatitis B.
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