| The author reviews his own clinical experiences and the international literature how to expand the number of used kidneys for transplantation, to achieve longer functioning graft and patient survival, and experimentally use topical for avoiding drug side effects. In the case of an extended criteria donor dual kidney transplantation seems to be a good solution. According to our 5 patients, 2 years graft and patient survival and graft functions are good, especially for older recipients without major surgical complication. In the case of donors under the age of 5 we used the kidneys separately as single transplants instead of the most widely used en bloc transplants. We compared 38 pediatric kidney transplants to 121 "ideal adult donor" (18-45 years of age) transplants. Without surgical complications the pediatric kidney function was equivalent to that of "ideal" adult kidney transplants not showing deterioration over time. There were no graft losses due to technical reasons among pediatric transplants. Smaller pool of potential kidneys for transplant are influenced with progressive arterial diseases - such as fibromuscular dysplasia - and questioned to be suitable for transplants. Observing our 7 patients with FMD even count with the only case we reported we think that the overall risk to the potential donor remains unknown, the risk to the recipient is low compared with the potential benefits of transplantation.;The author observed new immunosuppressant combinations to prevent the transplanted organs in prematurely high risk ethnic groups. A concentration-controlled sirolimus-cyclosporine-prednisone regimen in 470 patients reduced the incidence of acute rejection episodes and increased 6-year graft survivals without an augmented toxicity profile. The author was one of the first clinicians who used Campath-1H, if the rejection was refracter to the usual therapy. Campath-1H is accepted in leukemia therapy and for induction due to its broad immunosuppressive act. We used it as rescue therapy in 5 patients became well tolerated, effective and relatively free of adverse events.;In an experimental study the author could prove significant wound healing impairment effect of sirolimus in mice using daily 8mg/kg sirolimus orally. He could document enhanced wound healing with the use of nucleotide topical especially in the first 2-6 days in the same experimental settings. |
