Immunologic Studies in Human Organ Transplantation

Abstract

Twenty-eight patients with chronic renal diseases and uremia were investigated with respect to their cutaneous responsiveness to a panel of antigens expected to elicit immediate and delayed hypersensitivity reactions. Compared to a control group, there was a marked decrease in the incidence of responses of both types. Eighteen patients received renal allografts from members of the control group and were available for restudy in the postoperative period prior to the institution of adrenal steroid therapy. Each recipient acquired delayed responsiveness with specificity identical with that of the kidney donor. The donor group was reactive to 49 antigens to which the recipients were non-reactive preoperatively. Postoperatively, 40 of these reactivities were observed in the recipients. This successful demonstration of the transfer of immunologically competent tissue in association with renal transplantation indicates that the cause of depressed cutaneous hypersensitivity in uremia is not an inability of the skin per se to react.

Serotyping for Homotransplantation V. Evaluation of a Matching Scheme

“…First, since kidney transplant recipients often receive transfusions it is possible that transfused lymphocytes multiply (6,12) and survive in the recipient, thus leading to spurious typing results. This is particularly likely, for uremics are often immunologically crippled (9,26) and are given immunosuppressive treatment with the transplant. If such chimerism were established within the host it would affect the results of the test only if the donor's cells comprised more than 10% of the total population.…”

“…As an example, upon deliberate immunization of Rh-negative volunteers with Rh-positive red blood cells if the ABO types were incompatible, as many as 28 out of 32 immunized persons failed to produce antibodies (19) Wiener, et al (25) also could not produce red cell antibodies in all 18 individuals immunized against M, K, P, and S antigens despite immunizations over a period of 17 months. If this type of unresponsiveness to known allogeneic antigens in normal persons is added to now well established knowledge of the immunologic unresponsiveness of the uremic state (9,26) it should be expected that some recipients may have survived in spite of mismatched antigens. Although this may account for some survivors with many incompatibilities, immunologic unresponsiveness probably does not play a more dominant role than histocompatibility matching, for with equivalent immunosuppression a larger proportion of recipients who received grafts from related donors survived than those who received grafts from unrelated donors (7,10,17).…”

Surgically Correctable Intra-Abdominal Complications Before and After Renal Homotransplantation

“…Uremia is a notorious cause of a variety of gastrointestinal disorders including pain, gastrointestinal bleeding, pancreatitis, enterocolitis, and ileus. 2 , 8, 9, 13 In addition, the immunologic reactivity of the patient with renal failure is often reduced 3,6 so that he can less effectively deal with intraperitoneal sepsis.…”

The Role of Organ Transplantation in Pediatrics

“…Reactivity to various test antigens is reduced. 23,68 Nevertheless none of the 18 surviving pediatric patients has been troubled with recurrent late infection.…”