This study is a multifactorial analysis of 389 transplants performed from June 1977 to December 1981. Analysis of the effects of transfusions antilymphocyte serum (ALS), histocompatibility testing, gender, and patient risk factors (presence of concomitant disease, greater than 50 years of age, etc.) was done. Two-hundred fifty-three patients received cadaver kidneys and 136 patients obtained kidneys from a relative. Two-hundred eighty-three (73%) patients received blood transfusions prior to transplantation. Our data showed that recipients receiving transfusions prior to transplantation had a significantly higher graft survival than those who were not transfused in both cadaveric and related graft recipients. Two-hundred twenty-one (56%) patients received ALS following the transplant. This group had a 15% higher graft survival than a comparable group. Analysis of histocompatibility testing data shows approximately 5% higher functional graft survival between each match grade. Surprisingly, female patients receiving kidneys from living related donors had a 16% higher graft survival than male patients. In cadaver recipients female patients had a 10% higher patient survival as compared to male patients. The risk factor status of recipients affected not only graft survival but patient survival, which probably is due to the consequences of immunotherapy. The authors' conclusion is that the above mentioned factors may be additive in nature. Further, multivariable analysis is necessary in order to correctly transplant data.
Natural cell-mediated cytotoxicity has been shown to be age-dependent in both rats and mice. The present study was undertaken to study age-related levels of natural cytotoxicity in humans. Mononuclear peripheral blood cells from over 200 normal volunteers were co-incubated with 51Cr-labeled K-562 for 4 h and the supernatants assayed for released isotope. No striking age-related variations in natural cytotoxicity were observed. Cord blood was shown to exhibit both high and low levels of natural cell-mediated cytotoxicity. There was no significant difference in the levels of natural cytotoxicity between males and females. Thoracic duct lymphocytes (TDL) from prospective kidney graft recipients were tested for natural cytotoxicity at intervals during drainage. Natural cytotoxic activity was undetectable in samples from initial drainage but increased as the drainage progressed. This increased activity was correlated with decreased in vitro responsiveness to PHA and decreased levels of E-rosettes in these TDL.
During a 2-year interval 206 patients underwent renal transplantation at a single center, 38 of whom underwent bilateral nephrectomy and other adjuvant operations as part of the transplant procedure. The indications for this type of procedure were reviewed, with special emphasis on the control of hypertension. The morbidity and mortality (16 per cent) in this group were compared in detail to those in patients not undergoing a concomitant adjuvant operation. The results with regard to renal function were similar to the group as a whole and the indications for appropriate patient selection are discussed.
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