Cadaveric Renal Allograft Research Articles

#5999 GRADES II-III INTRA-ABDOMINAL HYPERTENSION INCREASE THE RISK OF GRAFT LOSS OR DEATH AFTER KIDNEY TRANSPLANTATION

Abstract Background and Aims Intra-abdominal hypertension (IAH) is common among post-surgical, critically ill and kidney transplant patients, and is associated with acute kidney injury and increased morbidity and mortality. We aimed to describe the medium-term effect of IAH on graft and patient survival after deceased-donor kidney transplantation. Method 192 consecutive patients who received a cadaveric renal allograft transplant at our hospital were included in this study. IAP was measured every 8h for at least the first 72h after surgery using the urinary bladder technique, and an average value was obtained. Patients were followed up for 24 months or until a composite outcome (defined as graft loss or recipient death) occurred. Clinical, anthropometric, and analytical data was extracted from our hospital's database. Statistical analysis was performed using IBM SPSS Statistics 22. The study was approved by the local ethics committee. Results 192 patients were included. Relevant clinical and anthropometric data are summarized in Table 1. Patients with grades II or III IAH were more frequently male, had longer dialysis vintage, received more frequently hemodialysis as renal replacement therapy and suffered delayed graft function, graft loss or death more repeatedly. In Kaplan-Meier analysis, grade II IAH or higher were associated with lower composite-outcome free survival (Log-Rank: 8.053; p = 0.018) (Figure 1). Conclusion Grade II-III IAH appear to be a risk factor for graft loss or recipient death in our sample of deceased donor kidney transplant recipients. Monitoring of intra-abdominal hypertension could provide useful information to identify patients at higher risk of post-transplant complications.

Role of Diffusion Tensor Imaging in Functional Assessment of Transplant Kidneys at 3-Tesla MRI

Abstract Objectives The main purpose of this article is to measure the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of cortex and medulla of renal allograft using 3-Tesla diffusion tensor imaging (DTI) in renal transplant patients with normal and graft dysfunction and to assess the correlation between diffusion tensor parameters (ADC and FA) and the estimated glomerular filtration rate (eGFR) value. Materials and Methods Fifty renal transplant recipients who received either living or cadaveric renal allografts were included in the study. Blood samples for serum creatinine and eGFR value were taken on the same day prior to the magnetic resonance study and the patients were assigned to three groups (A, B, C) according to allograft function (eGFR levels). The mean ADC and FA values of the cortex/medulla in upper, mid, and lower poles were calculated from the DTI sequence. Statistical analysis was performed using paired sample Student’s t-test and one-way analysis of variance test. Results The mean ADC values of the cortex were higher than the medulla that was statistically significant. However, the mean FA values were significantly higher in the medulla than the cortex. Mean ADCs and FA of the renal cortex and medulla were significantly higher in group A patients with normal renal function than in group B and C with poor renal functions. The corticomedullary difference in the FA values was more in group A. However, this difference was lower in group B and more so in group C. Conclusion ADC and FA values in the renal cortex and medulla exhibit a good correlation with allograft function and were significantly lower in transplants with dysfunction than those with good function. FA values appear to be more sensitive than eGFR and ADC for detection of early pathological changes in the graft dysfunction.

Spectrum of asymptomatic bacteriuria in renal allograft recipients and its short-term effect on graft outcome: Experience of a Tertiary Care Center from Northwest India

Introduction: Asymptomatic bacteriuria (AB) is not uncommon after renal transplantation with limited data from developing countries; we did this study to assess the microbiological spectrum and its short-term graft outcome in our tertiary care center. Materials and Methods: It is a prospective observational study. We included all the patients who underwent renal transplantation over a period of 18 months, from January 2016 to June 2017. Patients who had indwelling urinary catheter beyond 5 days posttransplant and those with persistent graft dysfunction within 6 months of transplant were excluded from the study. Results: A total of 67 patients were included in the study with a mean age of 33.78 ± 8.91 years and a male-to-female ratio of 7:1; live-related donors were 36 (53.73%), live unrelated were 19 (28.35%), and 12 (17.91%) were cadaveric renal allograft recipients (RARs). Twenty-eight (41.79%) patients had 42 episodes of AB over 6 months of follow-up. The maximum episodes occurred within 1 month of postrenal transplantation, and 42 out of 67 (62.68%) RARs had bacterial growth in their double-J ureteral stents (USs). The most frequently isolated pathogen from urine was Escherichia coli (n = 14, 33.33%), whereas Pseudomonas aeruginosa (n = 10, 23.80%) was in US culture (USC). The prevalence of AB was higher in cadaveric RARs compared to live RARs (83.33% vs. 32.72%, P = 0.001) and with bacterial growth in the USC compared to those who did not show any growth in USs (57.14% vs. 16.0%, P = 0.001). However, the estimated glomerular filtration rate between those with AB and those without at 6 months of follow-up (66.36 ± 14.98 vs. 66.10 ± 13.83 ml/min/1.73 m2, P = 0.943) was not different. Conclusion: AB is not uncommon in RARs and it is more common in cadaveric RARs and those with growth in US culture without compromise in allograft function at 6 months postrenal transplant.

Summary of the Third International Workshop on Clinical Tolerance.

The Third International Workshop on Clinical Tolerance was held in Stanford, California, September 8-9, 2017. This is a summary of Workshop presentations of clinical trials designed to withdraw or minimize immunosuppressive (IS) drugs in kidney and liver transplant patients without subsequent evidence of rejection. All clinical protocols had in common the use of donor or recipient cell therapy combined with organ transplantation. Tolerance to HLA matched and mismatched living donor kidney transplants with complete withdrawal of IS drugs without subsequent rejection for up to 14 years of observation was achieved in more than 50 patients enrolled in trials in four medical centers after the establishment of transient or persistent chimerism. Complete IS drug withdrawal without chimerism was reported in a prospective trial of liver transplantation combined with injection of regulatory T cells. IS drug minimization without rejection was reported in recipients of living donor kidney transplants enrolled in the One Study consortium after injection of recipient regulatory T cells, or injection of donor regulatory monocytes or dendritic cells. In conclusion, considerable progress has been made in achieving IS drug withdrawal after cell therapy in recipients of organ transplants.

Rare clinical cases of “combined” skin carcinomas in cadaver renal allograft recipients

The most prevalent skin cancer in the transplant organ recipients is squamous cell cancer, followed by basal cell cancer. The skin cancer incidence and related mortality in the transplant organ recipient are significantly higher than those in the general population, which is to be linked with prolonged pharmaceutical immunosuppression. Multiple tumors are also typical for this patient group. The article describes two rare combinations of skin carcinomas with different histological characteristics in patients with cadaver renal allograft (CRA). Clinical case 1: A 43-year old female patient. In 2011, she was transplanted with a CRA due to end-stage renal failure caused by congenital cystic dysplasia (multicystic kidney disease), with subsequent removal of the allograft at 1.5 months after the transplantation. In 2014, she had her second CRA transplanted and until now is on immunosuppressive therapy. In 2013, the patient noticed two slowly growing masses in her right and left supraclavicular areas; they were clinically assessed as basal cell cancer and surgically resected. Histological examination of the resected skin fragments showed squamous cell carcinoma focuses in situ (Bowen's disease), with alternating superficial basalioma focuses; proliferating keratinizing squamous cell cancer with polymorphous structure, with prevailing acantholytic type, morphoeic basal cell carcinoma and basal squamous cell carcinoma were found throughout the dermal layer, up to the subcutaneous tissue. Clinical case 2: A 63-year old male patient was transplanted with CRA in 2007, due to end-stage renal failure caused by nephrolithiasis and chronic pyelonephritis. During the examination performed in 2013, a mushroom-like tumor (with a 3 cm diameter and a stipe of 1 cm in diameter, with erythematous tuberous surface) was found on the anterior neck surface, near the suprasternal notch. The tumor was surgically resected within the normal skin. Histological and immunochemical examinations showed that the mass consisted of two different tumors closely adjacent one to the other and separated by a narrow dermal layer, namely, neuroendocrine Merkel cell skin carcinoma and porocarcinoma with some signs of squamous cell and sebaceous cell differentiation.Conclusion: The descriptions of the rare cases confirm that transplantation-related skin cancers are highly relevant. Due to continuous renewal of the tissue components that is intrinsic to this organ, and due to deterioration of the immune control over proliferation and differentiation, they are characterized by a multiplicity of histological types and an unfavorable prognosis.

Isolated Neurogenic Bladder Associated With Human T-Lymphotropic Virus Type 1 Infection in a Renal Transplant Patient From Central Australia: A Case Report

BackgroundHuman T-lymphotropic virus type 1 (HTLV-1) is endemic amongst the Aborigines of the Northern Territory of Australia. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with this infection. In general population, isolated neurogenic bladder dysfunction in HTLV-1-infected individuals without HAM/TSP has been reported, and the HTLV-1 proviral load has been found to be higher in such patients compared with asymptomatic carriers. In solid organ transplantation, few cases of HAM/TSP have been reported worldwide, but not an isolated neurogenic bladder. CaseA 50-year-old indigenous women from Alice Springs with end stage renal disease secondary to diabetic nephropathy with no prior history of bladder dysfunction received a cadaveric renal allograft following which she developed recurrent urinary tract infections. The recipient was seropositive for HTLV-1 infection. HTLV-1 status of donor was not checked. Urodynamic studies revealed stress incontinence and detrusor overactivity without urethral intrinsic sphincter deficiency. She had no features of myelopathy. There was elevation of the serum and cerebrospinal fluid HTLV-1 proviral load. The magnetic resonance imaging myelogram was normal. Pyelonephritis was diagnosed based on clinical features, positive cultures, and renal allograft biopsy. Continuous suprapubic catheter drainage helped preventing further episodes of allograft pyelonephritis in spite of chronic colonization of the urinary tract. ConclusionIsolated bladder dysfunction is a rare manifestation of HTLV-1 infection and is probably associated with high proviral loads. This may adversely affect renal allograft and patient outcomes.

A double-blind randomised controlled investigation into the efficacy of Mirococept (APT070) for preventing ischaemia reperfusion injury in the kidney allograft (EMPIRIKAL): study protocol for a randomised controlled trial

BackgroundDelayed graft function (DGF) is traditionally defined as the requirement for dialysis during the first week after transplantation. DGF is a common complication of renal transplantation, and it negatively affects short- and long-term graft outcomes. Ischaemia reperfusion injury (IRI) is a prime contributor to the development of DGF. It is well established that complement system activation plays a pivotal role in the pathogenesis of IRI. Mirococept is a highly effective complement inhibitor that can be administered ex vivo to the donor kidney just before transplantation. Preclinical and clinical evidence suggests that Mirococept inhibits inflammatory responses that follow IRI. The EMPIRIKAL trial (REC 12/LO/1334) aims to evaluate the efficacy of Mirococept in reducing the incidence of DGF in cadaveric renal transplantation.Methods/designEMPIRIKAL is a multicentre double-blind randomised case-control trial designed to test the superiority of Mirococept in the prevention of DGF in cadaveric renal allografts, as compared to standard cold perfusion fluid (Soltran®). Patients will be randomised to Mirococept or placebo (Pbo) and will be enrolled in cohorts of N = 80 with a maximum number of 7 cohorts. The first cohort will be randomised to 10 mg of Mirococept or Pbo. After the completion of each cohort, an interim analysis will be carried out in order to evaluate the dose allocation for the next cohort (possible doses: 5–25 mg). Immunosuppression therapy, antibiotic and antiviral prophylaxis will be administered as per local centre protocols. The enrolment will take approximately 24 months, and patients will be followed for 12 months. The primary endpoint is DGF, defined as the requirement for dialysis during the first week after transplantation. Secondary endpoints include duration of DGF, functional DGF, renal function at 12 months, acute rejection episodes at 6 and 12 months, primary non-function and time of hospital stay on first admission and in the first year following transplant. Safety evaluation will include the monitoring of laboratory data and the recording of all adverse events.DiscussionThe EMPIRIKAL trial is the first study to evaluate the efficacy of an ex vivo administered complement inhibitor (Mirococept) in preventing DGF in cadaveric human renal transplantation. Mirococept has a unique ‘cytotopic’ property that permits its retention in the organ microvasculature.Trial registrationISRCTN registry, ISRCTN49958194. Registered on 3 August 2012.

TRANSLATIONAL CELLULAR IMMUNOTHERAPY FOR CADAVERIC KIDNEY ALLOGRAFT IN UROLOGICAL PATIENTS

Представлен первый отечественный опыт применения трансляционной клеточной иммунотерапии у реципиентов после аллотрансплантации трупной почки. Приведен анализ клинических, лабораторных и иммунологических данных, а также результаты протокольной биопсии трансплантата на 30-е и 180-е сутки после операции. Выявлены клинико-лабораторные, иммунологические и гистологические преимущества у больных основной группы. Установлены некоторые механизмы, раскрывающие возможности формирования иммунологической толерантности.

Prognostic Testing of Human Cadaveric Renal Allografts Pre-Transplant.

Background-The major limiting factor in Clinical Transplantation today is the shortage of cadaveric kidneys. The discard rate has been reported to be as high as 18%. Currently, there are no diagnostic tools available to accurately predict graft function pretransplant. Novel prognostic screening methodology that more accurately predicts posttransplant function could help to reduce the discard rate. In the present study we evaluated whether the restoration of synthetic functions during ex vivo near-normothermic perfusion, Exsanguinous Metabolic Support (EMS), could be used prospectively to evaluate function in human cadaveric kidneys. The blinded study involved human kidneys with varying cold ischemic times (CIT), a known mediator of damage, that ranged from 13 to 70 hours. Methods-Human kidneys (n=33) were procured following discard. Kidneys were received stored hypothermically, cannulated and transitioned to EMS warm perfusion (32°C). Perfusate samples were taken at various time points and evaluated using the Luminex xMAP to test for the cytokine/chemokine profiles. The results were categorized as Group 1 <24H and Group 2 >24H CIT. Results-From a panel of 35 cytokines/chemokines six parameters: IL-6, G-CSF, MIP-1α, MIP-1β, MCP-1, and IP-10, were significant. The concentration at 30 minutes of warm perfusion was compared to the concentrations at 9H. Group 2 kidneys with >24H CIT had significant reduction in the concentration of cytokines/chemokines that is dependent on new synthesis in comparison to Group 1 with <24H CIT. A surprising finding was that kidneys from diabetic donors with <24H of CIT had impaired restored synthetic function compared to kidneys from non-diabetic donors.Figure: No Caption available.Conclusion-Evaluating synthetic function by cytokine/chemokine analysis may represent a sensitive means of assessing cadaveric renal allografts prospectively. Prolonged CIT is known to be damaging. The blinded study results suggest that restored synthetic functions during an ex vivo warm perfusion could provide a means for evaluating grafts prospectively.

Association between interferon gamma +874 T&gt;A polymorphism and acute renal allograft rejection: evidence from published studies

Interferon gamma is involved in the acute rejection (AR) episodes of transplant recipients. However, results from published studies on the association of interferon gamma (IFNG) +874 T>A (rs2430561) polymorphism with AR of renal allograft are conflicting. To investigate the association between IFNG +874 T>A polymorphism with AR after renal transplantation, relevant studies were selected from PUBMED, EMBASE, Wanfang database and China National Knowledge Infrastructure until March 1st 2013. According the predesigned selection criteria, a total of 525 AR cases and 1,126 non-AR cases from 13 case-control studies were included to identify the strength of association with odds ratio (OR) and 95 % confidence intervals (95 % CI). Overall, a significant correlation between IFNG +874 T>A polymorphism and susceptibility to AR was detected (T allele vs. A allele: OR = 1.19, 95 % CI 1.02-1.38; TT/AT vs. AA: OR = 1.36, 95 % CI 1.07-1.73; TT vs. AA: OR = 1.42, 95 % CI 1.05-1.93; AT vs. AA: OR = 1.30, 95 % CI 1.01-1.68). In addition, ethnicity subgroup analysis revealed that high produce genotype (TT/AT) was associated with an increased risk of AR for Caucasians (TT/AT vs. AA: OR = 1.56, 95 % CI 1.14-2.12; TT vs. AA: OR = 1.64, 95 % CI 1.18-2.26). Furthermore, donor source subgroup analysis observed an increased risk for patients undergoing cadaveric kidney transplantation (TT/AT vs. AA: OR = 1.90, 95 % CI 1.12-3.24; TA vs. AA: OR = 2.16, 95 % CI 1.24-3.74). In conclusion, this meta-analysis suggested that IFNG +874 T>A polymorphism was associated with AR of renal transplant recipients, especially among Caucasians and those receiving cadaveric renal allograft. Additional well-designed studies with large sample size are warranted to validate our conclusion.

Nephrectomy in patients with Caroli’s and ADPKD may be associatedwith increased morbidity

Autosomal dominant polycystic kidney disease (ADPKD), characterizedby multiple bilateral renal cysts, is the most commoninherited disorder of the kidney and an important cause of endstagerenal disease (ESRD). Caroli’s disease is a much less frequentcondition with ectasia of the intrahepatic biliary system. A clearassociation between autosomal recessive and Caroli’s disease hasbeen described, but only 4 cases of ADPKD and Caroli’s diseasehave been reported with 2 postoperative mortalities. The aim of thiscase is to increase the awareness of intra-operative and postoperativecomplications. A 66 year-old male was diagnosed with ADPKDand Caroli’s disease with hepatosplenomegaly and 4 episodes ofascending cholangitis. After 3 years of hemodialysis for ESRD, hereceived a cadaveric renal allograft. Subsequently, he developedparoxysmal atrial fibrillation. Upon anticoagulation, he developedmultiple episodes of gross hematuria from the left native kidney.After the anticoagulation therapy was discontinued, he underwentbilateral nephrectomies of his native kidneys. Intra-operatively, asplenic laceration could not be managed conservatively. Therefore,splenectomy was performed. In addition, he developed ascendingcholangitis post-operatively that was treated with antibiotics. Hewas discharged on postoperative day 18. Genetic testing revealedthat the patient is heterozygote for a large deletion in PKD1 gene,which encompasses all tested exons (exons 1-44).

Pediatric Kidney Transplantation: A Single Center Experience With 134 Procedures

Renal transplantation confers substantial benefits on children with end-stage renal disease (ESRD), including improved growth as well as longer and better quality of life. The aim of this study was to report our experience with 134 pediatric renal transplantations. Epidemiological and clinical data of all patients transplanted who were younger than 18 years between January 1984 and May 2012 were collected from our prospective database. One hundred twenty-four patients (44% female) underwent 134 renal transplantations. Renal insufficiency was secondary to urological obstructive uropathy (46%), nephropathy (34%), and other causes (20%). Mean age at the time of the surgery was 13 years. Mean time of ESRD was 25 months. One hundred seventeen patients (95%) received cadaveric renal allografts. Mean cold ischemia time was 1302 minutes. Mean donor age was 19.7 years. Mean length of hospital stay was 17 days. Mean follow-up was 122 months. Graft survivals at 5 and 10 years were 84.1 and 71.9%, respectively. Ninety-six percent of kidney recipients were alive; 71% with functioning allografts. Mean current glomerular filtration rate among functioning kidneys is 55 mL/min. Renal transplantation in the pediatric population is a good option for ESRD patients.

Cytomegalovirus esophagitis presents as chest pain in a renal transplant recipient

Cytomegalovirus esophagitis presents as chest pain in a renal transplant recipient

Concomitant Epstein-Barr Virus (EBV)-Positive B-Cell and EBV-Negative T-Cell Posttransplant Lymphoproliferative Disorders After Renal Allografting: Pathogenetic Implications

Concomitant Epstein-Barr Virus (EBV)-Positive B-Cell and EBV-Negative T-Cell Posttransplant Lymphoproliferative Disorders After Renal Allografting: Pathogenetic Implications

Giant colonic ulcer and pseudopolyps in an immunodepressed patient

We read with interest the case report by Colaiacovo et al. describing a case of disseminated histoplasmosis in an immunodepressed patient [1]. We had a similar case of a 55-year-old African man who was evaluated for leucopenia and a persisting inflammatory syndrome. He had received a cadaveric renal allograft 2 years earlier because of glomerulonephritis, after which he had been treated with an immunosuppressive regimen of prednisone, tacrolimus, and mycophenolate mofetil. He had 1-month history of intermittent rectal bleeding, abdominal pain, and weight loss. Physical examination was unremarkable. Blood, urine, and stool cultures, chest radiograph, and testing for Clostridium difficile toxin, cytomegalovirus (CMV), Epstein–Barr virus, HIV, and parvovirus B19 infection were all negative. Abdominal computed tomography (CT) scan revealed a 5-cm thickened, stenotic segment of the right colon and enlarged mesenteric lymph nodes suggestive of carcinoma ([Fig. 1]).

Nephrectomy in patients with Caroli’s and ADPKD may be associated with increased morbidity

Autosomal dominant polycystic kidney disease (ADPKD), characterized by multiple bilateral renal cysts, is the most common inherited disorder of the kidney and an important cause of end-stage renal disease (ESRD). Caroli's disease is a much less frequent condition with ectasia of the intrahepatic biliary system. A clear association between autosomal recessive and Caroli's disease has been described, but only 4 cases of ADPKD and Caroli's disease have been reported with 2 postoperative mortalities. The aim of this case is to increase the awareness of intra-operative and postoperative complications. A 66 year-old male was diagnosed with ADPKD and Caroli's disease with hepatosplenomegaly and 4 episodes of ascending cholangitis. After 3 years of hemodialysis for ESRD, he received a cadaveric renal allograft. Subsequently, he developed paroxysmal atrial fibrillation. Upon anticoagulation, he developed multiple episodes of gross hematuria from the left native kidney. After the anticoagulation therapy was discontinued, he underwent bilateral nephrectomies of his native kidneys. Intra-operatively, a splenic laceration could not be managed conservatively. Therefore, splenectomy was performed. In addition, he developed ascending cholangitis post-operatively that was treated with antibiotics. He was discharged on postoperative day 18. Genetic testing revealed that the patient is heterozygote for a large deletion in PKD1 gene, which encompasses all tested exons (exons 1-44).

Periumbilical parasitic thumbprint purpura: Strongyloides hyperinfection syndrome acquired from a cadaveric renal transplant

Periumbilical parasitic thumbprint purpura may be a presenting sign of hyperinfection strongyloidiasis in the immunocompromised host. We report a case of fatal hyperinfection strongyloidiasis acquired from a cadaveric renal allograft, diagnosed by the pathognomonic periumbilical thumbprint purpuric eruption, confirmed by skin biopsy and laboratory testing.

Unusual acute promyelocytic leukemia following de novo renal transplant: case report and literature review

Acute promyelocytic leukemia (APL) with transcripting three isoforms of mRNA from PML-RAR alpha fusion genes following renal transplantation has never been reported in the literature. A 39-year-old man received a cadaveric renal allograft for IgA chronic kidney disease in 2006 and was consecutively immunosuppressed by tacrolimus, mycophenolate mofetil, and prednisolone. In 2008, he presented with gum bleeding and weight loss. Following bone marrow biopsy, we diagnosed acute promyelocytic leukemia. Molecular analysis demonstrated atypical presence consisting of three isoforms of mRNA from PML-RAR alpha fusion genes. The patient was administered with three courses of consolidation chemotherapy plus atretinoin, resulting in complete remission and did not jeopardize his allograft function. This novel finding suggests that the leukemogenesis of APL may be polyclonal, sharing similar progenitor targeting on complicated karyotypes, responding well to current chemotherapy.

Pulsatile Perfusion of Kidney Allografts With Celsior Solution

Background Use of pulsatile perfusion (PP) to optimize outcomes in deceased donor renal transplantation remains controversial. This prospective analysis describes all cadaveric renal allografts transplanted at our center that were preserved with PP using Celsior solution. Methods We used the LifePort Kidney Transporter (Organ Recovery Systems) perfusion machine. Study outcomes included 1-year graft and patient survivals as well as rates of delayed graft function and need for posttransplant dialysis. Results Graft survival for PP was 90% and patient survival 100%. The incidences of delayed graft function was 10% and of posttransplant dialysis, 10%. Conclusion These data support the use of PP with Celsior solution.

Effect of Perioperative Administration of a Drug Regimen on the Primary Function of Human Renal Allografts

Delayed graft function (DGF) has one of the greatest effects on short- and long-term outcomes of cadaveric renal allografts. Ischemia reperfusion injury in the context of cold ischemia time and acute calcineurin inhibitor (CNI) nephrotoxicity is a major factor predisposing to DGF. A drug regimen consisting of prostaglandin E 1 (PGE 1) furosemide and dopamine has been used to reduce DGF after kidney transplantation. Prostaglandin E 1 has multiple anti-ischemic and tissue-protective abilities, furosemide improves diuresis, and dopamine augments renal blood flow and urinary volume. To evaluate a potential positive effect of this drug regimen on the primary function of cadaveric renal allografts, we performed a retrospective single-center study that compared 100 patients who received this regimen with a control group. The results showed no significant improvement in renal function. In contrast, plasma levels of creatinine and urea were increased in the drug regimen group. Thus, the effectiveness of PGE 1 in combination with high-dose furosemide and dopamine in diminishing DGF was not demonstrated in this trial.