Using a blood cell separator (IBM 2997^®), we have carried out lymphocytapheresis (LA) and plasma exchange (PE) as immunosuppressive methods in renal transplantation. LA was performed as a pretreatment in 29 patients who received renal grafts from living related donors (LRD). One-and three-year graft survival rates in LRD recipients pretreated with LA were 93% and 88%, respectively.
As an anti-rejection therapy, PE was performed in 14 episodes of acute rejection and five of chronic rejection. Acute rejection episodes treated with PE consisted of poor-risk patient episodes in which bolus steroid therapy was dangerous and in episodes of vascular-type rejection. As a result, in 14 acute rejection episodes treated with PE, there were complete responses in seven, incomplete responses in four and no responses in three. Of the five chronic rejection episodes treated with PE, two showed incomplete responses and three no responses.
Our study suggests that LA and PE are effective and safe immunosuppressive methods in renal transplantation.

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We evaluated the therapeutic effects of elastase, a natural pancretic enzyme, on lipid disorders and vascular calcification in dialysis patients, because this enzyme is said to have a unique action, not only on the elastin metabolism in the vascular wall, but also on the lipid metabolism. Hemodialysis patients were divided into two groups: the E group consisting of 50 patients with a mean age of 50.0±13.0 years was given elastase capsules (Elaszym) at a daily dose of 5, 400EL. unit; the C group, 24 patients with a mean age of 45.0±7.7 years served as controls. Patients with diabetes mellitus and those with X-ray findings of evident renal osteodystrophy were excluded from this study. Predialysis serum levels of total cholesterol, triglyceride, HDL-cholesterol and other routine blood chemistry were determined every other week. At the start of this study, there were no significant differences between the two groups in the levels of the parameters of the calcium metabolism and those of the lipid metabolism which showed only minor abnormalities, Throughout the year-long observation, no significant changes in the parameters of the lipid metabolism were noticed in either group. Changes on X-ray findings of the abdominal aorta were followed-up every three or six months for two years in 15 patients of the E group and 11 of the C group. The mean age was 57.4±9.0 years in the former group, and 47.5±7.9 in the latter. The mean period of hemodialysis therapy was 8.4±2.4 and 4.7±3.0 years, respectively. Although E group patietns had more risk factors affecting vascular changes such being older and having a longer period of dialysis therapy, a regression of calcification in the abdominal aorta was noticed in two out of 15 patients in this group, but none in the C group. Progression of vascular calcification was shown in five out of 11 patients in the C group and only two in the E group. No adverse effects were noticed, except for one patient who complained of a mild degree of heart burn after taking the elastase capsules. These results indicate that elastase may be a promising drug in treating vascular calcification in hemodialysis patients, but for lipid disorders, further studies in cases with more pronounced lipid abnormalities are needed.

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