Abstract P3-10-28: Breast Cancer Patients with Neoadjuvant Chemotherapy Have a Different Clinical Significance of the Ki-67 Expression before and after the Treatment

Background: Reliable predictive and prognostic markers for routine diagnostic purposes are needed for breast cancer patients treated with neoadjuvant chemotherapy (NAC). Ki-67 is a marker for proliferating cells and is overexpressed in many breast cancers. Aim of this analysis was to evaluate the potential role of Ki-67 as a biomarker for the breast cancer patients with NAC.

Patients and Methods: A retrospective search of a prospectively maintained clinical breast cancer database was performed to identify patients treated with NAC at the National Cancer Center Hospital East. The expression of Ki-67 was assessed using immunohistochemistry (MIB-1) in pretherapy core-needle biopsy and post-therapy surgical excision specimens. Levels of Ki-67 index (percentage of Ki-67 positive cancer nuclei) were dichotomized as high (over 10%) and low (less or equal 10%). Survival curve was calculated using Kaplan-Meier method. Log-Rank test was used to detect differences.

Results: Records were available for 296 patients who were received NAC (anthracycline and/or taxane based) between Nov 2001 and Nov 2009. High and low Ki-67 index in pre-therapy were 173 and 123 cases, respectively. 51 cases (17%) of all achieved a pathological complete response (pCR: no residual invasive disease in the breast). pCR rate (23%) in high Ki-67 was significantly different from that (9%) in low Ki-67. 5-year overall survival estimates were 69% and 75%, respectively. However, there was not difference between the groups in overall survival curve at a median follow-up time of 31 months. Of 245 cases with residual invasive, high and low Ki-67 index in post-therapy were 80 and 165 cases, respectively. 62 cases maintained high Ki-67 index before and after NAC, 94 cases maintained low Ki-67 index. There was significantly difference between high and low Ki-67 indexes of post-therapy in overall survival curve (P<0.01), 5-year overall survival estimates were 51% and 81%, respectively. Moreover, there was not significant different between 51 cases with pCR and low Ki-67 index in overall survival curve.

Conclusions: Although Ki-67 index in pre-therapy is a useful predictor for the therapeutic response to NAC, high Ki-67 index in pre-therapy dose not imply that the patients have a worse prognosis. Ki-67 index in post-therapy is useful to predict outcomes for patients with residual invasive disease.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-28.

Abstract P1-12-07: Neo-Adjuvant Exemestane in Post Menopausal Estrogen and/or Progesterone Receptor Positive Breast Cancer: A Randomized Phase II Trial To Investigate Optimal Duration (4 Month Versus 6 Month) of Preoperative Endocrine Therapy (PTEX46 Trial)

Background: Since the 1990s, primary endocrine therapy has been considered the gold standard in the adjuvant and metastatic treatment settings for estrogen and/or progesterone receptor (ER and/or PgR) positive breast cancer. This therapy has also been shown to be effective as neo-adjuvant endocrine therapy in these indications. In recent years, the focus of clinical interest has shifted to the third-generation aromatase inhibitors from tamoxifen. The optimal treatment duration time and causal relationship between neo-adjuvant endocrine therapy and survival, however, are not clear. We therefore conducted the present study to investigate the potential benefits of neo-adjuvant exemestane (E) therapy with the goal of identifying the optimal treatment duration (4 months versus 6 months).

Methods: Conducted at three hospitals in Japan, this study was a multicenter, randomized phase II trial of pre-operative E treatment in postmenopausal women with untreated primary breast cancer. Fifty postmenopausal women with ER positive and/or PgR positive invasive breast cancer were randomly assigned to E (25 mg/day) for 4 months (4 mo) or E (25 mg/day) for 6 months (6 mo). All patient data were collected by UMIN and were analyzed by the National Cancer Center in Japan. Tumor regression (by clinical examination, ultrasound, and MRI), pathological response, shift towards breast-conserving surgery, and safety assessments were the main outcome measures.

Results: Of the 50 patients that enrolled, 28 patients had undergone surgery. The mean ages in the 4 mo and 6 mo treatment groups were 66.7 years and 66.8 years, respectively. No significant differences in the patient characteristics were found in the two groups. The response rates (partial or complete responses) by clinical examination in the 4 mo and 6 mo groups were 37.5% and 50%, respectively. Pathological responses (minimal response or better) were found in 13.3% and 41.7% of patients and a partial mastectomy was performed in 50.0% and 58.3% of patients after 4 mo and 6 mo, respectively.

Conclusion: To date, the results of this study demonstrate that treatment with E for 6 mo was more efficacious than treatment with E for 4 mo. Further work is in progress to obtain data from additional patients and to identify the optimal duration of neo-adjuvant E.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-12-07.

A Retrospective Analysis of Risk Factors of Central Nervous System Metastases in Operable Breast Cancer: Different Survival by Biological Subtype and Ki67 Overexpression

Background: New agents have improved systemic disease control, but the control of central nervous system (CNS) metastases is still insufficient. The identification of factors that may predispose to CNS metastases may help lead to earlier detection possibly to improvement in disease management.Methods: Patients (pts) with metastatic who were diagnosed with clinical stage I-III primary breast cancer at National Cancer Center Hospital East from January 2003 to December 2005 were screened. All pts with CNS metastases were identified by CT or MRI. Cox proportional hazards models were fitted to find risk factors of CNS metastases. Factors included age, menopausal status, clinical stage, T stage, histological grade, lymphovascular invasion, hormone and HER2 status, and Ki67 (at least 30% tumor cells positive). Survival was calculated by the Kaplan-Meier method.Results: Median follow-up from operation was 53.5 months. Of 591 breast cancer pts, 76 pts (12.9%) relapsed. Seventeen pts (2.9%) developed CNS metastases; 5 pts developed as the first recurrence site. Multivariable analysis indicated the higher risk for developing CNS metastases were triple negative (TN) tumors (HR 5.532, 95% CI 1.445-21.180, p=0.013) and Ki67 overexpression (HR 3.906, 95% CI 1.179-12.939, p=0.026). There were no statistically significant differences in other factors. CNS metastasesCumulative incidence of CNS metastases (4 yrs)Median duration to CNS metastases (Months)Overall survival (4 yrs)Disease free survival (4 yrs)TN9.7% (9/93 pts)9.4%11.378.5%73.3%HER2 positive3.7% (4/107 pts)4.4%20.391.0%84.9%Others1.0% (4/391 pts)0.8% (p<0.0001)24.197.5% (p<0.0001)92.4% (p<0.0001)      Ki67 ≥30%8.6% (12/140 pts)9.4%12.382.4%75.0%Ki67 <30%1.1% (5/446 pts)0.7% (p<0.0001)23.996.7% (p<0.0001)92.0% (p<0.0001) Discussion: In our analysis, TN or Ki67 overexpression breast cancer showed earlier CNS metastases and shorter overall survival. In case of these tumors, there is higher probability for early detection of limited CNS metastatic involvement.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6053.

Step-up therapy with biphasic insulin aspart-70/30--Sapporo 1-2-3 study

The effectiveness of BIAsp 30 step-up therapy in achieving glycemic control in Japanese patients with type 2 diabetes mellitus was investigated. Study subjects were 99 patients with type 2 diabetes mellitus aged over 20 years who were judged to require insulin therapy due to poor glucose control (HbA1c level of > or =7.5%). BIAsp 30 dosage was determined by the patient's attending physician; coadministration of hypotensive agents and antilipemic agents was permitted, but OAD coadministration was limited to patients already receiving such drugs at the start of the study. Patients who did not achieve HbA1c <6.5% after 16+/-5 weeks with QD (Phase 1) were stepped up to BID (Phase 2). If patients still had not achieved HbA1c <6.5% after 16+/-5 weeks with BID, they were stepped up to TID (Phase 3). 55 of the 99 enrolled subjects completed the study and the rates of achievement of HbA1c <6.5% and HbA1c <7.0% were 45.5% and 74.5%, respectively. Of all registered subjects, 5.1% (5/99) achieved HbA1c <6.5% in QD, 19.5% (16/82) in BID, and 20.6% (7/34) in TID. Statistically significant reductions in HbA1c levels were recorded at the conclusion of each phase, with no incidents requiring intervention, indicating that BIAsp 30 step-up therapy is a safe, simple therapy that can be useful in achieving better glycemic control for Japanese patients with type 2 diabetes mellitus.

Terahertz optical clock generation with tunable repetition rate and central wavelength using variable-bandwidth spectrum shaper

Recently, a number of high-speed optical clock generation technologies have been developed due to their potential useful applications in different fields. Here, we propose a new terahertz optical clock generation technique with tunable repetition rate and central wavelength. The proposed optical clock generator consists of an frequency comb light source and a variable-bandwidth spectrum shaper (VBS). The VBS can generate arbitrary repetition rate pulse trains and waveform by controlling each spectral mode. We experimentally demonstrated optical clock generation with repetition rates of 1.28, 2.56, 3.0, and 4.0 THz.

Age-related three-dimensional morphological changes in rat motoneurons innervating diaphragm and longissimus muscles

We investigated age-related morphological changes of rat motoneurons innervating diaphragm muscle (DI-MN) and lumber longissimus muscle (LL-MN) in which quite different activation patterns exist. In young (2-4 months) and old (24-26 months) rats, the motoneurons innervating both muscles were labelled retrogradely by intramuscular injection of cholera toxin B subunit. After a 4-day survival, horizontal slices of the spinal cord were processed with immunohistochemical staining (first antibody to cholera toxin B subunit and second antibody with Cy3) and observed with a confocal microscope. Three-dimensional reconstruction of labelled motoneurons was performed to examine soma and dendrite morphology. As compared to the soma volume in young rats, significantly smaller values were found in old rats in both motoneurons and the degrees of decline were 16.1% in DI-MN and 20.3% in LL-MN. Significant decreases in the thickness of primary dendrites were also found in both motoneurons, and the degrees of decline were 17.5% in DI-MN and 22.3% in LL-MN. Smaller changes were found in DI-MN than in LL-MN, indicating the possibility that increased activation by central drives can attenuate age-related morphological changes of the motor system in the spinal cord.

[Minimally invasive cardiac surgery for transposition of the great arteries in neonates]

We evaluated our results of arterial switch operation (Jatene) for complete transposition of the great arteries between May 2003 and October 2005 particularly concerning various operation-related durations. Twenty neonates were studied. The mean age and body weight were 11.6 +/- 2.7 (range 5 to approximately 15) days and 3.0 +/- 0.4 kg, respectively. Duration of anesthesia, operation, extracorporeal circulation (ECC), and aortic cross-clamp were 199.4 +/- 30.1, 162.7 +/- 29.9, 91.6 +/- 8.8 and 59.8 +/- 8.1 minutes, respectively. Time differences between anesthesia and operation, operation and ECC, ECC and aortic cross-clamp were calculated, and their correlations with the duration of anesthesia were investigated. The items, whose coefficient of correlation with anesthetic time was greater than 0.6 were operation time, ECC time, aortic cross-clamp time, operation time minus ECC time, and operation time after ECC come-off. Furthermore, the operation time after ECC come-off was strongly correlated with plasma lactate concentrations and intraoperative bleeding. In conclusion, the time required for hemostasis and closure of the chest should be as short as possible. Therefore secure anastomoses with least hemorrhage possible is important.

Multiple drug-resistant gene 1 in children with steroid-sensitive nephrotic syndrome

BACKGROUND

A full dose of corticosteroid is required to induce complete remission (CR) in steroid-sensitive nephrotic syndrome (SSNS), unless it is possible to taper and discontinue along with the course after CR. But the mechanism of this change in steroid sensitivity remains unknown. P-glycoprotein (PGP) can eliminate given corticosteroids from cytoplasm, which results in corticosteroid resistance. Therefore, drug delivery was analyzed using real-time polymerase chain reaction (PCR) of multiple drug-resistant gene 1 (MDR1; encoding PGP) mRNA expression.

METHODS

Fourteen patients with SSNS (male/female: 14/0; age: 1-23 years; mean 10.4 years) were enrolled in the study. MDR1 mRNA gene expression of peripheral blood nucleated cells (PBNC), before and after CR (19 sets of blood samples), was quantified using real-time PCR.

RESULTS

The MDR1 mRNA levels before CR were variable in each patient, but there was an apparent decrease in the MDR1 gene expression of PBNC after CR (P < 0.003).

CONCLUSION

PGP may play a role in the tapering of corticosteroids after CR in SSNS.

Efficient use of hybrid Genetic Algorithms in the gain optimization of distributed Raman amplifiers

In this paper, we propose an efficient and accurate method that combines the Genetic Algorithm (GA) with the Nelder-Mead method in order to obtain the gain optimization of distributed Raman amplifiers. By using these two methods together, the advantages of both are combined: the convergence of the GA and the high accuracy of the Nelder-Mead. To enhance the convergence of the GA, several features were examined and correlated with fitting errors. It is also shown that when the right moment to switch between methods is chosen, the computation time can be reduced by a factor of two.

Immunoadsorbent apheresis eliminates pathogenic IgG in childhood lupus nephritis

BACKGROUND

It is suggested that the highly cation-charged fraction of the IgG and IgG3 subclasses may play a pathogenic role in lupus nephritis. In contrast, immunoadsorbent therapy using a sodium dextransulfate fixed cellulose gel column-low invasive selective immunoadsorbent apheresis therapy (SDSC-IAT) has been applied to lupus nephritis with favorable results. However, elimination using pathogenic IgG by SDSC-IAT has never been investigated.

METHOD

Two patients with diffuse proliferative lupus nephritis were treated using SDSC-IAT concomitant with immunosuppressive therapy. The eluates from the SDSC, and the patients' serum obtained before and just after SDSC-IAT were subjected to an IgG charge analysis using isoelectric focusing and immunoblotting, and also to laser nephelometry assay, which is used for measuring IgG subclass concentration. Indirect immunofluorescence staining was performed to detect IgG subclass deposition in the glomerulus.

RESULTS

Both of the patients had an immediate decrease in anti-double-strand DNA antibody and in the circulating immune complex with a following clinical improvement. Repeated biopsies demonstrated improvement of glomerular lesions with a marked reduction of IgG and C3 deposition. The IgG of the SDSC eluates consisted of highly cation charged (isoelectric points: 9-10) fractions. In addition, IgG3 was specifically removed from the patients' serum using an SDSC among the IgG subclasses. The subclass of deposited IgG in the glomeruli showed IgG3 predominance.

CONCLUSION

SDSC-IAT specifically removed the highly cation charged fractions of IgG and IgG3 from the patients' serum and the elimination of these fractions may have resulted in clinical improvement.

[Surgical treatment for pulmonary aspergillosis with hyper immunoglobulin-E syndrome; report of a case]

A 6-year-old girl who had been diagnosed as hyper immunoglobulin-E syndrome, was admitted to the department of pediatrics of our institute in May 2006, because of pulmonary aspergillosis. The chest X-ray showed bilateral cavities with niveau and fungus ball in the left middle lung field. In spite of medical treatment by antibiotics and antimycotics, the lesions did not improve. Therefore, bilateral lobectomy was done. After surgery, she needed re-operation twice, because of prolonged air leakage. There are few reports of lung surgery for the patient with the hyper immunoglobulin-E syndrome, and we present our case and review previous 2 case reports in the Japanese literature.

Sentinel node biopsy in primary breast cancer: Radioactive detection and metastatic disease

AIM

To examine the relationship between the intensity of the radioactive counts and the presence of tumor metastasis in sentinel lymph nodes (SLNs) in order to correctly identify the number of SLNs to be removed.

PATIENTS AND METHODS

Five hundred three breast cancer patients with successful radioisotope localization of SLNs using the combined blue dye and radioisotope method were analyzed. SLN biopsy was continued until all the blue-stained and radioactive nodes were removed.

RESULTS

The mean number of harvested SLNs was 1.7+/-0.9, and the number of radioactive SLNs among the harvested nodes was 1.6+/-0.8. SLN metastasis was found in 123 of the 503 cases. The metastasis was detected in the SLN with the highest radioactive count (the hottest SLN) in 94 of the 123 cases with positive SLNs. The positive rate in the hottest SLN was 89% in 61 cases with a single radioactive SLN, and 65% in 62 cases with multiple radioactive SLNs. Of the 29 cases with positivity in other than the hottest SLNs, the metastasis was detected in the second hottest SLN in 16 cases, in the third hottest SLN in one case, in a mixture of negative radioactive SLNs and blue-dye-stained in four cases, and in the negative SLNs and positive non-SLNs (false-negative) in eight cases. Of 123 node-positive cases, 111 cases had metastasis that was detected within the first three hottest SLNs.

CONCLUSIONS

These data suggest that lymph node metastasis may not always be detected in the hottest SLN. Thus, in practice, all radioactive and/or blue-dye-stained nodes should be removed for further examination.

Phase II study of S-1 as a first-line, S-1 plus cisplatin as a second-line, and weekly paclitaxel as a third-line therapy in patients with advanced gastric carcinoma

15186

Background: We conducted a pilot phase II study to evaluate the efficacy and safety of S-1 as a First-line, S-1 plus cisplatin as a second-line, and weekly paclitaxel as a third-line therapy for advanced gastric cancer. Patients and Methods: Between 2002 and 2005, 19 patients were enrolled into this study. Chemotherapy consisted of 60 mg/m2 of S-1 for 4 weeks at 6 weeks interval, 60 mg/m2 of S-1 for 3 weeks and 60mg/m2 Cisplatin on day 8 at 5 weeks interval, and paclitaxel 60 mg/m2 day 1, 8, 15 at 4 weeks interval. Results: The response rate was 15.8%, 7.7%, and 0% in the first-, second-, and third-line, respectively. The time to progression was 314 days. The mean survival time was 994 days. The median survival time was not calculated because 12 patients are still alive. With respect to hematological toxicity, the major adverse effect was leukopenia, which reached grades 3–4 in all line. And non-hematological toxicities, the major adverse effect was anorexia, which reached grade 3–4 in the Second line, and no deaths were attributable to the adverse effects of the drugs. Conclusion: This sequential therapy was very effective treatment for advanced gastric cancer with acceptable toxic side-effects.

No significant financial relationships to disclose.

Triggers of relapse in steroid-dependent and frequently relapsing nephrotic syndrome

An awareness of the triggers of relapse is critical for the control of steroid-dependent, frequently relapsing nephrotic syndrome (SDFRNS). We have investigated the triggers, usually described as 'episodes', to such relapses within a temporal context. Thirty-five patients with SDFRNS were analyzed retrospectively. A total of 442 relapses occurred in 2499 patient-months. The relapses were classified into two groups: those with episodes (E+) and those without episodes (E-). There were 135 E+ relapses and 296 E- relapses. The common cold was the most common episode (52%) of E+ relapse, followed by school events (18%). These E+ relapses occurred almost evenly throughout the 4 weeks between each follow-up visit. Conversely, 161 (55%) of the 296 E-z relapses occurred within the 3-day period preceding the patient's appointment (relapse-related hospital visit, RRHV). McNemar's test revealed that the concentration of relapses in this period was statistically significant (P < 0.00011). In addition, 15 out of 26 RRHV without additional therapy showed a spontaneous remission. From a chronological perspective, the common cold and school events as well as up-coming hospital visits may trigger relapses in SDFRNS patients.

Unilateral adrenalectomy improves insulin resistance and polycystic ovaries in a middle-aged woman with virilizing adrenocortical adenoma complicated with Cushing's syndrome

A benign virilizing adrenal adenoma is rare among adrenal neoplasms in middle-aged women. A 39-yr-old Japanese woman who presented with hirsutism, obesity, diabetes mellitus and hypertension was admitted. Plasma concentrations of testosterone and DHEAS were high. While the basal level of plasma ACTH was suppressed, serum cortisol level was high and its circadian rhythm was absent. Serum cortisol level was not suppressed with the low- and high-dose overnight dexamethasone suppression test. Abdominal computed tomography showed a left adrenal tumor, and an adrenocortical scintigraphy revealed uptake of the tracer on the left side. Polycystic ovaries were also found and bone mineral density revealed osteoporosis. Histopathological features of resected adrenal tumor were consistent with those of adrenocortical adenoma. Immunoreactivity of all the steroidogenic enzymes was apparent in the tumor cells and particularly dehydroepiandrosterone sulfotransferase (DHEA-ST) immunoreactivity was markedly expressed. Cortical atrophy and reduced expression of DHEA-ST were detected in the cortex of the adjacent non-neoplastic adrenal gland. Plasma testosterone, DHEAS and cortisol levels returned to normal after surgery, concomitantly with the disappearance of polycystic ovaries. This is a very rare case of virilizing adrenocortical adenoma complicated with Cushing's syndrome (CS).

Impact of isolated tumor cells in sentinel lymph nodes detected by immunohistochemical staining

AIM

Isolated tumor cells (ITCs) in lymph nodes are defined histologically as node-negative. The clinical impact of ITCs in sentinel lymph nodes (SLNs) remains unclear. We report the prognosis of breast cancer patients with ITC-positive SLNs detected by immunohistochemical staining.

PATIENTS AND METHODS

One hundred and sixty-five breast cancer patients with histologically negative SLNs were seen between January 1998 and December 2000. In 69 patients, sentinel node biopsy (SNB) was immediately followed by axillary lymph node dissection, and 96 had undergone SNB alone. Permanent sections of 301 SLNs were re-examined after hematoxylin-eosin staining and cytokeratin 19 immunohistochemical staining.

RESULTS

ITCs were found in 18 SLNs of 17 patients and a micrometastasis was found in one SLN of one patient. As of November 2005, only one patient with ITCs in one SLN had supraclavicular lymph node recurrence. In contrast, 18 of the 147 patients with negative SLNs had tumor recurrence. Surgical management of the axilla had no influence on recurrence-free survival in all of the patients.

CONCLUSION

This study shows that breast cancer patients with ITC-positive SLNs should be clinically managed as node-negative patients.

Field trial of time-spreading and wavelength-hopping OCDM transmission using FBG en/decoders

In this paper, field trial on optical code division multiplexing through the commercial-used fiber line is presented. We fabricated fiber Bragg grating en/decoders with time-spreading and wavelength-hopping scheme, considering environmental fluctuation of transmission fiber. 200 km-long transmission of 2-channel x 10 Gb/s signals was achieved on the field photonic network test bed of JGN II. Error free transmission was demonstrated in real field deployed single-mode transmission fiber.

A survey of peritonitis and exit-site and/or tunnel infections in Japanese children on PD

To obtain data on peritonitis and exit-site and/or tunnel infections (ESI/TI) in Japanese children undergoing peritoneal dialysis (PD) from January 1999 through June 2003, we surveyed 22 members of the Japanese Study Group of Pediatric Peritoneal Dialysis (JSPPD) by questionnaire. One hundred and thirty patients were eligible. Seventy episodes of bacterial peritonitis occurred in 45 patients (0.17 episodes/patient-year), and 123 ESI/TI occurred in 60 patients (0.29 episodes/patient-year). S. aureus and MRSA were found to be the causative organisms in 39% and 13% of the peritonitis episodes, and in 59% and 20% of the ESI/TI, respectively. Tunnel infection was found in 55% of the MRSA peritonitis episodes. Eleven percent of the peritonitis episodes relapsed, and 19% needed hemodialysis. One patient died due to MRSA peritonitis. The PD catheter was removed in all fungal and 78% of MRSA peritonitis. However, the type of organism did not influence the need for catheter-related surgery for ESI/TI. Neither peritonitis nor ESI/TI was prevented by the use of a swan-neck catheter, a downward-pointing exit site, povidone iodine exit-site care, bathing instruments, or nasal mupirocin. In conclusion, MRSA peritonitis was not uncommon in children in Japan, was frequently associated with tunnel infections, and had a poor outcome. No association was found between the occurrence of infection and preventive measures previously reported as effective. Alternative approaches are needed in children, especially for MRSA.

Kidney Transplantation in Pediatric Recipients With Mental Retardation: Clinical Results of a Multicenter Experience in Japan

BACKGROUND

There are few published reports on kidney transplantation (KT) in physically handicapped patients with mental retardation. The aim of this study is to clearly identify the outcome of KT in these patients and clarify whether handicapped patients can be candidates for KT.

METHODS

Our study identified 25 multiply handicapped transplant recipients from 8 institutions. Causes of mental retardation were chromosomal abnormality in 5 patients, genetic syndrome in 10 patients, developmental brain anomaly in 2 patients, and other or unknown causes in 8 patients. Primary diseases leading to end-stage renal disease were congenital urinary tract anomaly in 12 patients, focal segmental glomerulosclerosis in 3 patients, cystic kidney disease in 3 patients, and other in 7 patients.

RESULTS

Twenty-three patients received living-related transplants from a parent and 2 patients received cadaver transplants. Twenty-two patients were on peritoneal dialysis therapy, 2 patients were on hemodialysis therapy at the time of KT, and 1 patient underwent preemptive KT. Eleven acute rejection episodes occurred in 8 patients. All episodes were completely reversed with treatments that included mainly methylprednisolone pulse therapy. Posttransplantation lymphoproliferative disorder occurred in 2 patients. Follow-up data showed that all grafts were functioning during a mean observation period of 41.1 months (range, 4 to 187 months). All persons providing primary support for patients were satisfied with the KT and believed that quality of life was improved in both transplant recipients and themselves.

CONCLUSION

Results indicate that KT is not contraindicated in handicapped patients, but cannot determine which patients are unsuitable to undergo KT.