Failure of Regional Immunosuppressive Therapy to Modify Renal Allograft Rejection

Localized immunosuppression for pulmonary transplants

“…Dougherty, Nehlsen, Minick, and Veith (1968) treated two groups of canine renal allografts by intra-arterial infusion with heparin alone in one group and with one of three different corticosteroids alone in the other, without recording the details of commencement and termination of the infusions. The treatments were not successful in prolonging the periods of graft function in either group.…”

Locoregional Immunosuppression of Organ Transplants

“…Unfortunately, the impressive results obtained with local steroid administration alone in a rat transplant model (Ruers et al 1986a(Ruers et al , 1988 have not been achieved in previous canine renal allograft studies with local (Terz et al 1969, Ackermann & Barnard 1966, Dougherty et al 1968 or systemic (Homan et al 1980) administration. Moreover, clinically successful use of intrarenal steroid infusion to reverse early rejection episodes has been limited to bolus administration of methylprednisolone in combination with other agents against a background of multimodality immunosuppression (Kountz & Cohn 1969, Laupacis et al 1982.…”

“…Investigation of the efficacy o( local steroid treatment of allografts began in the mid-1960's when it was demonstrated that continuous i.a. infusion of cortisone (Ackermann & Barnard 1966), hydrocortisone (Dougherty et al 1968), prednisolone (Dougherty et al 1968), or high-dose prednisone (Terz et al 1969) into canine renal transplants using external syringe pumps or i.v. infusion sets produced no significant differences in survival time or time to rejection when compared with untreated controls.…”

“…Conflicting reports regarding the efTectiveness oflocal treatment of canine and human renal allografts appeared in the 196O's (Miura et al 1964, Retik etal. 1966, Terz et al 1969, Ackermann & Barnard 1966, Dougherty et al 1968, Kountz & Cohn 1967. This line of investigation was then abandoned for 15 years until Ruers et al {1986a) demonstrated that continuous intraarterial (i.a.)…”