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Wednesdav. September 9. 1987 / University Daily Kansan
Nation/World
Tissue-matching is key to kidney transplants
The Associated Press
PITTSBURGH — Anti-rejection drugs have contributed to making four out of five kidney transplants initially successful, but tissue-matching is the key to survival over the long term, a specialist said yesterday.
Only 30 percent of the transplanted organs are still functioning after 10 years, said Paul Terasaki, professor of surgery at the University of California at Los Angeles.
"We think the new emphasis should be on long-term success," he said.
Terasaki, who keeps a world registry of kidney transplants, reported at the International Organ Transplant Forum in Pittsburgh that about 80 percent of all transplanted kidneys are functioning a year after the operation, twice as many as 25 years ago.
Of the patients who live for a decade, most got organs from donors whose tissue matched their own as closely as possible, said Terasaki.
their own as chief counsel, the prosecutor is higher than with mismatch," he said.
Transplant pioneer Thomas E. Starzel, a professor of surgery at the University of Pittsburgh, said, "Matching doesn't really count very much for the first year, maybe for the first five years. But there is going to be an impact in matching that comes up at 10 years."
An individual's tissue can be typed in much the same way that blood is typed. Tissue types are more complex than blood types, however, so perfect matches are rarely achievable.
Terasaki said the results for long-term survivors were the same regardless of whether the
patients had been administered cyclosporine, a drug which suppresses the body's natural defenses against foreign tissue. The breakthrough medication was approved by the U.S. Food and Drug Administration for general use in 1983.
"Cyclosporine increases the one-year survival but does not do anything for the long-term survival rates." Terasak said. "Matching is in what the long-term rates can be increased."
Doctors don't understand why cyclosporine appears to lose its effectiveness with time, said Jean Borel, a researcher at Switzerland's Sandox Limited who helped develop the drug.
Although the nation's 184 kidney transplant centers try to match the tissue of organ donors and recipients as closely as possible, limited
supplies of donor organs too often prevent optimum matches.
"You can't wait for matching to occur because it doesn't happen that often in the general population," said Arthur Harrell of the American Council on Transplantation.
About 11,000 people are awaiting kidney transplants at any one time in the United States, according to Harrell. A record 8,973 of these patients have been discharged nationwide in 1966, up from 7,699 the year before.
Effective Oct. 1, the United Network for Organ Sharing, a transplant umbrella group, will require the nation's 200 transplant centers to share kidneys that have specific characteristics to be good matches. Such organs represent fewer than 5 percent of all donated kidneys.
Court revives lawsuit on safety defects against Ford
WASHINGTON — A federal appeals court yesterday revised a lawsuit to force the Transportation Department to reopen its investigation of alleged safety defects in Ford Motor Co. cars made before 1979.
The Associated Press
The U.S. Circuit Court of Appeals here ruled that a lower court judge had improperly dismissed a lawsuit by the Center for Auto Safety to force the National Highway Transportation Safety Administration to reopen
the investigation of transmissions in 23 million Ford cars.
U. S. District Judge Charles Richey had ruled that NHTSA's refusal to reopen the investigation could not be reviewed by courts.
But the opinion of the appellate judges said "denials of petitions to investigate alleged safety defects . . . are subject to judicial review under the Administrative Procedure Act" to assure that NHITS properly enforces its auto safety standards.
A NHTSA spokeswoman said the agency would not comment on the court's decision.
The appeals court sent the case back to Richey with instructions to examine NHTSA's technical review to determine if the agency properly determined there was not a likelihood of a mechanical defect.
The case stems from the Center for Auto Safety's efforts in 1985 to force a new investigation of Ford transmissions that critics contend slide from park to reverse when the car's motor is running.
The court said Richey should not just rely on "merely the statement of reasons given by the administrator" in making his decision.
in the waning days of the Carter administration, the Transportation Department reached a settlement with Ford under which the company mailed warning stickers to owners of cars telling drivers about the possible danger.
Stickers and letters were mailed to the owners of 23 million cars made between 1966 and 1979.
The dashboard stickers warn motorists not to release the brake when the car is running and in park.
The appeals court in 1982 upheld the settlement, rejecting a petition by the Center for Auto Safety.
The center filed its new petition in 1965, claiming that the alleged defect was continuing to cause deaths and injuries.
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