Outcomes may differ after kidney transplantation compared to combined liver-kidney transplantation. In animal models, distinct patterns of antidonor immunoglobulin (Ig) G subclasses are associated with either rejection or transplant tolerance. Flow cytometry has increased the sensitivity of antidonor immunoglobulin detection. We compared antidonor IgG subclass responses in kidney transplant recipients to those in recipients of liver or multiorgan grafts. In this study of 19 organ (kidney, liver, pancreas) transplantations, recipient serum incubated with donor splenocytes was tested by flow cytometry for the presence of IgM, IgG, or IgG subclass 1 -4. Sera before transplantation and 10 days and 100 days after transplantation were used. No differences were seen in antidonor IgM, IgG, or IgG subclass antibodies among recipients of kidney transplants and liver grafts or combination grafts, either before or after transplantation. IgG4 gradually but significantly increased after transplantation in all groups. High levels of antidonor IgG3 either before transplantation or produced after it were found in 3 kidney recipients who experienced acute rejection. No other patients experienced rejection, and no other increase in IgG3 was seen. In conclusion, antidonor IgG subclass profiles may be useful to distinguish populations at risk of rejection but they do not differentiate the immunological response after kidney transplantation from that after liver or combined transplantation. A late rise in antidonor IgG4 is consistent with decreased antidonor reactivity thought to occur late after transplantation. (Liver

The mechanism by which a liver transplantation might protect a simultaneous kidney transplant in a crossmatchpositive recipient is unknown. Flow cytometry crossmatch (FCXM) has increased the sensitivity of donorspecific antibody (

This book concerns two generations of physicians: Archibald Malloch, his son Thomas Archibald and their famous colleagues Joseph Lister and William Osler. A century ago, they lived through times of great change in medicine and in society. A study of their lives would be instructive for this alone as changes loom large once again. This thoroughly researched and well written book, the last by the late Charles Roland, has even more value because the title's epithet could as easily be applied to the author, who was both a noted physician and a fine citizen, as it is to Malloch père. From a log cabin in northern Manitoba, via the University of Toronto and the Manitoba Medical College, to general practice in southern Ontario, Roland actually lived the growth of Canada in the 20th century, just as the Mallochs experienced its sometimes painful early development. Roland left Ontario in 1964 to become an editor with the Journal of the American Medical Association and later Chair of the Department of Biomedical Communications at the Mayo Clinic. Whether or not it was his fondness for Osler studies that led Roland to McMaster University in 1977, as the first Hannah Professor in the History of Medicine, we cannot say, but the situation was fortunate because it brought him to the home ground of the Mallochs and the Oslers. Roland's academic career was as noted for its scholarship as he was known for generous collaboration and gentle mentorship, features he shared with the subjects of his book. It is poignant for the reviewers to look upon photographs of Archibald Malloch Sr. in kind old age and see reminders of his sadly missed biographer. Archibald Malloch (1844-1919) grew up in Brockville, Ontario and attended university in Kingston before going to Glasgow in Scotland to complete his medical education (1867). Canada watched anxiously as large armies demobilized south of its border while its leaders, most of whom were known personally to the Mallochs, set about the task of building a new country. Documentary gaps in Malloch's story are expertly filled by the author with a comprehensive picture of life at that time just as the description of Malloch's education at Queens' University is enriched by the author's detailed knowledge of medical education and examination during that period. Malloch's professor of anatomy, Dr. Michael Sullivan, sought to improve the standard required for practice in Ontario. As Chief Examiner, he brought a cadaver on the train from Kingston to Toronto and questioned candidates on material not available in Gray's textbook.