改良胰液空肠引流式胰肾同期联合移植35例报告

目的报告应用改良胰液空肠引流式胰、十二指肠及肾同期联合移植(SPK)的外科技术治疗35例胰岛素依赖型糖尿病并发尿毒症的近期效果。方法2000年6月-2006年1月,35例胰岛素依赖的糖尿病合并尿毒症患者接受SPK,移植胰的外分泌采用空肠内引流,不作Roux-en-Y型吻合。移植肾平均冷缺血时间为(6．92±2．17)h,移植胰平均冷缺血时间为(9．65±2．02)h。术后早期采用他克莫司、霉酚酸酯及皮质激素预防排斥反应,同时以抗淋巴细胞球蛋白或抗CD25单克隆抗体诱导治疗。结果围手术期患者存活率达97．1％(34／35),存活病例全部停用胰岛素,平均停用胰岛素时间为(8．3±4．5)d,空腹血糖恢复正常时间为(13．4±8．9)d。术后3周口服糖耐量试验、胰岛素和C肽释放试验显示移植胰功能完全正常。血淀粉酶恢复正常时间平均为(9．3±7．0)d。肾功能延迟恢复(DGF)5例,血肌酐恢复正常时间平均为(58．2±16．8)d,其余30例血肌酐恢复正常时间平均为(7．7±5．4)d。术后主要外科并发症为移植胰伤口感染、胰十二指肠-空肠出血和移植肾周围出血。3例(8．6％)因并发症再次手术,未发生与胰液引流术式相关的并发症如胰漏、肠漏、腹腔脓肿及肠梗阻等。结论SPK是治疗1型和部分2型糖尿病并发尿毒症的有效方法;改进的胰液空肠引流术式(不作Roux-en-Y吻合)有助于降低胰液空肠引流术式的术后早期并发症发生率。     

胰液空肠引流术式胰肾联合移植(附10例报告)

总结10例胰液空肠引流(ED)术式胰肾一期联合移植(SPK)的外科技术和治疗胰岛素依赖型糖尿病(IDDM)合并尿毒症的效果。方法2000年6月至2003年7月间完成改进的ED术式SPK10例,不做Roux-en-Y吻合。免疫抑制治疗术后早期采用四联诱导治疗(FK506／CsA MMF 皮质激素 ALG或抗CD25单抗),以后改为三联维持。结果10例手术均获得成功,移植肾功能即刻恢复,除1例移植胰功能延迟恢复外．余9例术后1周内血糖降至正常水平,完全停用外源性胰岛素。1例术后6月带正常移植物功能死于心肌梗塞,4例存活已超过1年;发生急性排斥反应4例次。除1例难治性排斥未能逆转行再次肾移植外．余3例经激素冲击或()KT3治疗均获好转。并发症情况：出现腹腔感染与切口感染各2例,肾周血肿1例,分别经手术探查或引流换药治疗后愈合。结论改进的ED术式胰肾联合移植安全、简单,无严重外科并发症,是值得推广的治疗IDDM合并尿毒症的理想方法。     

改良肠引流式胰肾联合移植的外科技术及临床应用

目的报道改良胰液空肠引流式胰肾联合移植的外科技术和其治疗糖尿病合并尿毒症的近期效果。方法2000年6月至2006年8月,共有38例糖尿病合并尿毒症患者在华中科技大学同济医学院附属同济医院接受胰肾联合移植,移植胰腺的外分泌液用空肠内引流,不作Roux-en-Y吻合。移植胰腺及肾脏的平均冷缺血时间分别为（10±2．0）h和（7±2．0）h。除1例外,术后早期均采用他克莫司、霉酚酸酯及皮质激素预防排斥反应,同时以抗淋巴细胞球蛋白或抗CD25单克隆抗体诱导治疗。结果受者、移植肾脏和胰腺的6个月存活率均为97．4％,平均停用胰岛素时间为（7±6．9）d,空腹血糖恢复正常的平均时间为（14±9．1）d。术后3周口服糖耐量试验、胰岛素和C肽释放试验显示移植胰腺功能完全正常。血淀粉酶恢复正常的平均时间为（10±7．7）d。肾功能延迟恢复8例,其血肌酐恢复正常的平均时间为（53±20．0）d;其余30例血肌酐恢复正常的平均时间为（8±7．4）d。术后主要外科并发症为移植胰腺伤口感染、胰十二指肠-空肠吻合口出血和移植肾脏周围出血,3例（7．9％）因并发症再次手术,未发生与胰液引流术式相关的并发症如胰漏、肠漏、腹腔脓肿及肠梗阻等。结论胰肾联合移植是治疗1型和部分2型糖尿病合并尿毒症的有效方法;改进的胰液空肠引流术式（不作Roux-en-Y吻合）有助于降低胰液空肠引流术式的术后早期并发症发生率,提高受者和移植物的存活率。     

胰肾联合移植的外科并发症分析

目的：总结分析胰肾一期联合移植(SPK)外科并发症的发生情况、原因和处理方式。方法：12例Ⅰ型糖尿病合并尿毒症患者施行了SPK，最初2例应用胰液膀胱引流(BD)术式，另10例为改进的胰液空肠引流（ED）术式。术后早期采用他克莫司(FK506)／环孢素A(CsA)加霉酚酸酯(MMF)、皮质激素、抗淋巴细胞球蛋白(ALG)或抗CD25单抗四联诱导治疗，以后改为三联维持。抗凝治疗使用肝素和低分子右旋糖酐。结果：12例手术均获成功，术后移植胰、移植肾功能恢复良好，停用了外源性胰岛素。外科近期并发症；腹腔感染3例，切口感染2例，分别经引流、换药后二期愈合；肾周血肿2例，经手术探查、清理后好转，多与抗凝剂短期应用过量有关。远期并发症：2例BD术式患者长期存在化学性膀胱炎，其中1例发生2次反流性移植物胰腺炎，经保守治疗后好转。所有病例术后均未发生吻合口漏和移植物血管血栓形成等严重并发症。结论：外科并发症的综合防治是SPK成功的关键之一。     

改良的胰液空肠引流式胰、肾一期联合移植(附2例报道)

目的 报告2例改良的胰液空肠引流式胰、十二指肠及肾联合移植的外科技术和治疗胰岛素依赖型糖尿病并发尿毒平的效果。方法 2000年6-9月,2例胰岛素依赖型糖尿病并发尿毒症的患者接受胰、十二指肠及肾一期联合移植,移植胰的外分泌采用空肠内引流,不作Roux-en-Y型吻合,结果 移植后,立即停用胰岛素,肾功能1-5d恢复正常,无外科并发症,未发生排斥反应,患者目前已分别存活5个月和2个月,移植胰和移植肾功能均正常,一般情况良好。结论 改良的胰液空肠引流式胰、十二指肠及肾联合移植技术简单、安全,是治疗I型糖尿病并发尿毒症的较好术式。     

胰、肾同期联合移植治疗糖尿病合并尿毒症40例

目的 报告40例胰、肾同期移植(SPK)治疗糖尿病合并尿毒症的结果 及经验.方法 共40例糖尿病合并尿毒症病人接受SPK,平均年龄为(45.8±8.2)岁.供肾先植入左侧髂窝.供胰植入右下腹腔,移植胰动脉与右侧髂外动脉端侧吻合,移植胰静脉与右侧髂外静脉端侧吻合.其中胰液膀胱引流术式2例,改进的胰液空肠引流术式38例.移植肾平均冷血时间为(7.13士2.02)h,移植胰平均冷缺血时间为(9.95±2.01)h.术后早期采用皮质激素+霉酚酸酯+他克莫司(36例)/环孢素A(2例)+抗淋巴细胞球蛋白(ALG)或抗CD25抗体四联诱导治疗,以后改为三联维持.结果 受者、移植肾和移植胰6个月存活率均为97.5%,1年存活率均为94.8%,受者、移植胰和移植肾3年存活率分别为94.8%、84.3%和84.3%.39例停用胰岛素,平均停用胰岛素时间为(6.87士6.80)d,空腹血糖平均恢复正常时间为(13.68士9.05)d.术后3周口服糖糖耐量试验、胰岛素和C肽释放试验显示移植胰功能完全正常.血淀粉酶恢复正常时间平均为(10.24±7.72)d.肾功能延迟恢复(IX;F)8例,血肌酐恢复正常时间平均为(52.75±20.01)d,其余30例血肌酐恢复正常时间平均为(8.03±7.39)d.术后主要外科并发症为移植胰伤口感染、胰十二指肠一空肠出血和移植肾周出血,3例(7.9%)因并发症再次手术,未发生与胰液引流术式相关的并发症如胰漏、肠漏、腹腔脓肿及肠梗阻等.结论 (1)SPK是治疗糖尿病合并尿毒症的有效方法 ;(2)改进的胰液空肠引流术式更简化、安全,更符合生理.     

胰液肠内引流式胰及肾一期联合移植：附1例报告

为1例2型糖尿病并尿毒症患者实施胰液肠内引流式胰及肾一期联合移植，患者术后1周内脱离胰岛素及透析治疗，随访4个月，胰腺及肾功能恢复正常。提示胰液肠腔引流式胰肾联合移植更符合正常生理状态，是治疗2型糖尿病并发尿毒症的有效方法。预防并发症的发生能有效提高生存率。     

胰液肠腔引流式胰十二指肠及肾一期联合移植一例报告

目的 总结胰液肠腔引流式胰肾联合移植的经验，探讨联合移植用药量，减少并发症。方法 对1例I型糖尿病并发尿毒症患者施行胰液肠腔引流式一期联合移植，术后早期应用他克莫司（FK506）、霉酚酸酯（MMF）、皮质激素和抗胸腺细胞球蛋白（ATG）进行免疫抑制治疗。监测胰腺、肾的功能恢复情况。结果 术后第3d，受者血肌酐、尿素氮恢复正常，术后第4d出现FK506中毒，致尿量减少，经调整FK506用量及进行血液透析过度无尿期，术后第10d，肾功能恢复正常；术后第5d停用胰岛素，移植胰内外分泌功能正常，术后第20d并发消化道出血，使用善得定及施他宁治疗痊愈。无其它外科并发症。结论 （1）胰液肠腔引流术式优于胰液膀胱引流术式；（2）胰液肠腔引流式胰、十二指肠及肾联合移植是治疗胰岛素依赖型糖尿病并发尿毒症的有效方法；93）优质的供者及良好的配型可减少并发症的发生。     

改良式胰液肠腔引流胰十二指肠及肾一期联合移植(附二例报告)

目的 研究改良式胰液肠腔引流胰十二指肠及肾一期联合移植的效果、术式、用药量及并发症。方法 对2例1型糖尿病并发尿毒症患者施行改良式胰液肠腔引流胰十二指肠及肾一期联合移植，术后早期应用他克莫司(FK506)、霉酚酸酯(MMF)、皮质激素和抗胸腺细胞球蛋白(ATG)进行免疫治疗。监测胰腺、肾功能恢复。结果 2例患者术后第3—5天肌酐、尿素氮恢复正常，术后第5—10天停用胰岛素，移植胰腺分泌功能正常。例1术后第7天出现FK506中毒，尿量减少，经调整FK506用量及血液透析过度，术后第25天肾功能恢复正常；例2术后第20天并发消化道出血，使用生长抑素及基因重组凝血因子Ⅶa等治疗痊愈。随访3—24个月，移植胰和移植肾功能均正常，一般情况良好。结论 改良式胰液肠腔引流胰十二指肠及肾一期联合移植是治疗胰岛素依赖型糖尿病合并肾功能衰竭的较好术式，优质供体及良好配型可减少并发症的发生。     

门、肠引流式胰肾一期联合移植5例报告

目的:总结胰腺内分泌门静脉引流、外分泌肠腔引流式（PE）一期胰、肾联合移植的临床经验。方法：对5例1型糖尿病并发尿毒症患者施行PE一期胰、肾联合移植术的临床资料及手术技术和非手术性并发症的预防进行回顾性分析。结果：5例手术均获成功，其中3例恢复良好，2例围手术期死亡，分别死于胰漏感染和FK506药物中毒。存活者术后3d血肌酐、尿素氮恢复正常;术后7d停用胰岛素，移植胰内、外分泌功能正常。结论：PE引流式胰腺移植在生理、代谢和免疫学等方面更具优势和合理性;PE式将是胰腺移植优先选择的术式;加强围手术期管理有助于减少术后并发症，取得良好疗效。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.