Aust. N.Z. J. Med. (1979), 9, pp. 473 474 ~



Sir. Various studies, including platelet survival and renal platelet localisation. have shown platelet involvement in the rejecting allograft. During rejection, glomerular and vascular thrombosis are prominent and the earliest lesion in the glomerulus is the formation of platelet aggregates and thrombi. Beta-thromboglobulin (BTG), a platelet specific protein released during platelet aggregation. was measured in 1 1 post-transplant patients with chronic rejection (serum creatinine 0 . 2 5 f 0 . 0 5 mmo1:l). The diagnosis of chronic rejection was based on histological evidence of chronic vascular rejection present more than six months after transplantation. The patients did not receive antiplatelet agcnts for at least one week prior to testing. Twelve transplant patients with serum creatinine concentrations < 0.11 mmolj/ and whose renal biopsies showed no evidence of chronic vascular rejection were studied as a

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control group. These two groups of transplant patients differ with respect to renal function as patients with chronic vascular rejection and normal renal function are not available for comparison. The mean BTG concentration ( 1 13.8 5 16.1 ng:ml) in the patients with rejccting allografts was significantly diff'ercnt from that of the transplant control group (41 3 f 15.8 ngjml, P < 0.005) and from that a group of 20 nontransplant patient controls with normal renal function and no renal disease (mean 32.6 6 . 2 nglml. P < 0 . 0 0 1 ) as well as a group of 40 healthy controls (mean 1 9 . 0 k 2 . 0 ng:nd, P < 0.001). BTG concentrations in the rejecting transplant patients showed no correlation with their levels of serum creatinine or blood pressure. Although a contribution of impaired renal function cannot be excludcd as a mechanism, the data suggest that BTG may serve as an indicator of the development of chronic vascular rejection. K. 'I. WOO. B. J . R. J U N O K . .%.J. F. d'APICE. J. A. WHITWORTH

and P. KINCAID-SMITH. Department of Nephrology, Royal Melbourne Hospital, I'arkville, Victoria 3050


Sir, The letter of Dr. Steiner, Honorary Secretary of the Royal Australasian College of Ophthalmologists concerning diabetic retinopathy has been noted by the Council of The Australian Diabetes Society. We share his desire to call attention to the need for early recognition of the condition in light of the potential dangers of diabetic retinopathy and to the fact that specialised techniques of investigation and treatment exist. We are sensitive to the needs for accurate evaluation of retinal appearances in the follow up of our diabetic patients and this Society is recommending a significant ophthalmological training as a component of the education of phq sicians whose major commitment is care of the diabetic.

Additionally, our Council sees potential dangers in the dichotomy of management of the diabetic where separatc disciplines manage different aspects of the spectrum of diabetic disease. Thus, we urge collaboration between ophthalmologists, other involved medical specialists and physicians primarily concerned with the care of diabetics so that management of diabetes related diseases can be co-ordinated and integrated in the total care of the patients. PINCIJS I'AF?'. I'rcsidciit. Australian Diabetes Society (On behalf of the Council) Reference: 1

S I I N H hl IIc179) Diaktic

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I 7 J Zfcu 9. 88

Diabetic retinopathy.

Aust. N.Z. J. Med. (1979), 9, pp. 473 474 ~ LETTERS TO THE EDITOR BETA-THROMBOGLOBULIN IN TRANSPLANT REJECTlON Sir. Various studies, including plat...
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