The dramatic improvement observed in the short term of graft survival following the introduction of cyclosporine A, led many transplant doctors to think that long term patient and graft survival will also show similar improvement. This has not been the case and after the first year, the survival curves run parallel to those observed during the earlier years. In an analysis of 446 patients whose grafts functioned for more than 1 year, chronic rejection alone accounted for more than 80% cases of graft loss among the 53 cases with progressive graft failure. Previous acute rejection was found to be an important predisposing factor to chronic rejection in these cases. Since chronic rejection is still an untreatable condition, all efforts should be made to prevent acute rejection in the hope that this may lessen the likelihood of late graft failure.

It is well known that uremia is associated with increased susceptibility to infection. In addition, patients on haemodialysis (HD) experience a variety of dialysis associated complications, both acute and chronic, many of them having features similar to acute phase response. Immunoregulatory cytokines such as tumor necrosis factor-a (TNF-a) have been implicated in the pathogenesis of immunological as well as inflammatory diseases. Thus, TNF-a levels could be expected to be high in uremic patients as well as in HD patients. We investigated the plasma levels of TNF-a in 17 patients with renal failure, seven patients with chronic renal failure (CRF) before commencement of HD and 10 patients maintained on regular HD. Eight age matched healthy subjects were studied as normal control. All CRF patients, who were not yet on dialysis, had high plasma levels of TNF-a (mean + SD 71.33 + 33.25 pg/ml). Out of the HD group, TNF-a plasma levels were not detectable in five patients and in the remaining five, TNF-a plasma level (mean + SD 21.06 + 7.72) were comparable to the normal controls (mean + SD 21 + 7.87). Our findings suggest that factors related to uremia, but not to HD, are responsible for high TNF-a plasma levels in these patients and that, HD probably has a beneficial effect by removal and/or neutralising of uremic toxins.

A study was undertaken to evaluate the safety and efficacy of iron saccharate in regular haemodialysis (HD) patients receiving r-HuEPO. A total of 109 patients (57 males, 52 females, mean age 34.1 + 11.7 years) were included in the study, 64 of whom were iron deficient. The patients were divided into two groups. Group I (n = 58) received high dose iron saccharate (500 mg), intravenously (i.v.) (1-2 doses), and Group II (n = 51) received low dose iron saccharate (100 mg), i.v., thrice per week (5-10 doses). Results at four weeks showed a significant increment in hemoglobin (Hb), hematocrit (Hct), and serum ferritin in both groups. Two patients developed headache, fever and urticaria, and three patients developed fever in group I. None of the patients in group II developed any adverse reaction. Intravenous iron supplementation with iron saccharate in HD patients showing poor response to r-HuEPO, produced satisfactory Hct levels without major side effects and without the need to increase the dose of r-HuEPO. Commonly observed side effects were not seen with the low dose regimen.

Soon after its introduction, continuous ambulatory peritoneal dialysis (CAPD) became the choice mode of dialysis treatment for small children. With the advent of automated machines, continuous cycling peritoneal dialysis (CCPD) is now finding more favor in many centers. Initial cost of CCPD is higher due to the need for automated machines, but puts much less strain on the family. However, there is evidence that biochemical control is better with CAPD. Growth and nutrition in both groups are found to be similar. CCPD may have advantages over CAPD with regard to infection, since the former has fewer disconnections. The same is also true with regard to hernias and leaks. Some patients still prefer CAPD, since it allows more freedom in life style compared to CCPD.

The clinical, biochemical and histological data are reported in a female infant with rapidly progressive renal failure, hepatosplenomegaly and death at the age of 2 years. This case represents another example of the newly described entity "chronic tubulo­interstitial nephritis with hepatic involvement" and the only reported case of this kind from this part of the world.