Renal transplantation was performed successfully in five cases with high risk. All are alive with functioning grafts at the time of report.The first patient was suffering from cardiac failure, and he was operated on immediately after an implantation of a pace-maker. The second patient was having malignant hypertention before and after transplantation, and bilateral nephrectomy through a mid-line abdominal incision was done, resulting in gradual decline of blood pressure to within normal range. The third patient suffered from chronic pye-litis, and renal transplantation was done immediately after bilateral nephrectomy. The fourth patient suffered from chronic renal failure and leukopenia (total white count 2900-4000/mm3), and the total white count became normal (5000-7500/mm3) despite the use of immunosuppressive drugs after renal transplantation. The fifth case, ages 50, developed stress ulcers with repeated massive hematemesis and bloody stools 12 days after transplantation, and a subtotal gastrectomy was performed to save the patient.It is the opinion of the author that the renal transplantation may be considered to be a life-saving operation, and the key of success is that the quality of the graft should be good.

Objective To investigate the role of sICAM-1 and TNF in the acute rejection of renal graft. Methods Serum sICAM-1 and TNF were sequentially determined in 41 patients with renal graft by ELISA and L_(929) target cell methods. Results The change of serum sICAM-1 was same as TNF, there was no significant difference in serum sICAM-1 and TNF among healthy controls, uremic patients, CsA toxioosis and stable transplantation. During acute rejection(AR) and infection episode, both serum sICAM-1 and TNF were obviously elevated. While the serum creatinine had no significant changes during infection, the serum sICAM-1 and TNF were elevated as early as 1～3 days before the rise of serum creatinine. Conclusion The serial assay of serum sICAM-1 and TNF would be helpful in the early diagnosis and differential diagnosis of AR.