Serotyping for Homotransplantation V. Evaluation of a Matching Scheme

Abstract

SummaryAn attempt was made to determine whether 36 long-term kidney homograft recipients and their donors were compatible for 7 major leukocyte groups. It was found that 21 of these recipients were surviving 2 to 3 years in spite of incompatibility for 1 or 2 major leukocyte antigens. Survival of mismatched grafts does not itself indicate that the antigens being measured are not transplantation antigens, for it was shown that the 15 recipients with no groups of mismatch were clinically superior to those with group incompatibilities. Moreover, histopathologic scores given to biopsy specimens taken 2 to 3 years after transplantation were significantly correlated with the number of group mismatches. Because the leukocyte groups were determined by cytotoxicity reactions of peripheral blood lymphocytes, the results may have been influenced considerably by chimerism in chronically dialyzed uremic patients or change in lymphocyte antigenicity or susceptibility to lysis upon prolonged immunosuppressive treatment. Although the possibility of these complications could not be ruled out in all instances, it was shown that 52 dialyzed uremic patients and 49 patients who had been treated with immunosuppression for over 1 year did not possess more or less antigens than a random population of normal individuals. It is concluded that: (1) the major leukocyte antigens are histocompatibility antigens and (2) since survival can be attained at times despite mismatches for these groups, the antigens are of intermediate strength and kidney homograft rejection may occur if excessive numbers of antigens are incompatible or if particular combinations of antigens are mismatched.

Avenues of future research in homotransplantation of the liver with particular reference to hepatic supportive procedures, antilymphocyte serum, and tissue typing

“…More complete data were subsequently obtained from correlation of two year findings on biopsy in these same patients with the quality of the Terasaki match. These studies by Porter et al [25,27] indicated a high degree of correlation between the state of morphologic preservation of the renal homograft and the completeness of antigen matching.…”

Chronic Survival After Human Renal Homotransplantation Lymphocyte-Antigen Matching, Pathology and Influence of Thymectomy

“…To test this hypothesis, the antigenic mismatches of the donor-recipient pairs were compared to those which were obtained from control studies of a random population sample. 66 The most important data are those from the five living patients in whom homografts from nonrelated donors were employed; the results from these cases in comparison to those expected from random population matching between nonrelatives are summarized in Figure 20. In all five instances, the incidence of mismatches of those possible was 14.4 per cent or less.…”

Humoral Antibodies in Patients After Renal Homotransplantation

“…The most completely characterized of these antibodies is detectable by virtue of its reactivity with a heterogenetic antigen found in sheep red cell stromata, which remains in the sheep cell membrane after the isophile component is removed by boiling (27). a series in which donors were selected prospectively by the Terasaki method on the basis of the best available match (33). The two others received cadaveric homografts in which it was not attempted to evaluate the biologic suitability of the donor in advance.…”