RESUMO
The effects of HLA-A and B matched pretransplant blood transfusions on the survival of a primary cadaveric kidney graft were studied prospectively in a group of 15 patients who had never received a transfusion and had never been pregnant. Kidney graft survival at one year was 87%, whereas a group of 14 nontransfused patients who underwent transplantation in the same center (before this study was initiated) had a graft survival of only 7%. Twenty-six patients who received a transplant in the same center just before and after each protocol patient served as controls. There were no prior pregnancies in this group; all patients had received blood transfusions from random blood bank donors. Kidney graft survival at one year was 76% for this control group, which is not statistically different from that found for the protocol group. Graft survival for the 13 contralateral kidneys from the protocol group donors was only 50% at one year. These kidneys, however, were transplanted in various other centers. From our study, prolongation of kidney graft survival could be demonstrated for patients receiving pretransplant HLA-A-and-B-matched blood transfusions. Sera screening indicated that lymphocytotoxicity might be reduced by pretransplant HLA-A-and-B-matched blood transfusions. The presence of pretransplant antibodies with specificities for HLA-A and/or B could be significantly correlated with poor graft survival.
Assuntos
Transfusão de Sangue , Sobrevivência de Enxerto , Antígenos HLA/análise , Transplante de Rim , Adolescente , Adulto , Soro Antilinfocitário/análise , Cadáver , Criança , Feminino , Antígenos HLA/genética , Antígenos HLA-A , Antígenos HLA-B , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Cuidados Pré-Operatórios , Distribuição AleatóriaRESUMO
The effects of HLA-A and B matched pretransplant blood transfusions on the outcome of primary cadaveric kidney transplantation were studied prospectively in a group of 15 patients who had never received a transplant and had never been pregnant. From our study, prolongation of graft survival could be demonstrated for patients receiving pretransplant HLA-A and B matched blood transfusions. The clinical course was comparable to that found in a group of patients who received random pretransplant blood transfusions, although there were considerably more patients in this latter group hospitalised for a very long period, a fact which could be attributed mainly to viral infections.
Assuntos
Transfusão de Sangue , Sobrevivência de Enxerto , Antígenos HLA/imunologia , Transplante de Rim , Adolescente , Adulto , Tipagem e Reações Cruzadas Sanguíneas , Cadáver , Seguimentos , Rejeição de Enxerto , Antígenos HLA-A , Antígenos HLA-B , Teste de Histocompatibilidade , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Viroses/imunologiaRESUMO
A less aggressive approach in treatment of rejection crises has been introduced since January 1979. Findings in 39 patients demonstrate that rejection treatment can be started later and be applied with considerably less frequency without an increase in graft loss. A reduction of more than 50% in corticosteroid dosage applied within three months after transplantation seems to be possible, with a sharp decrease of morbidity rate.
Assuntos
Rejeição de Enxerto/efeitos dos fármacos , Transplante de Rim , Prednisona/uso terapêutico , Cadáver , Seguimentos , Humanos , Prednisona/administração & dosagem , Transplante HomólogoRESUMO
Anatibodies directed against the plasma membrane of renal collecting ducts were found in the sera of two out of 101 renal allograft recipients. The sera also reacted with the epithelium of the renal pelvis, the ureter, the ductus deferens, the skin, the oesophagus, the trachea and the bile ducts of random individuals, indicating that the antibodies were directed against a widespread epithelial antigen. The antibody activity against these structures was removed by absorption of the sera with homogenized renal medullary tissue; absorption with plasma proteins, erythrocytes, spleen leucocytes or platelets did not influence the antibody titers. In the two patients with circulating antibodies, the graft function was unremarkable eight and fifteen months after transplantation, respectively. From this study we conclude that circulating epithelial antibodies directed against the collecting ducts of the graft are of little or no clinical importance.
Assuntos
Anticorpos , Transplante de Rim , Túbulos Renais Coletores/imunologia , Túbulos Renais/imunologia , Adulto , Especificidade de Anticorpos , Sítios de Ligação de Anticorpos , Epitélio/imunologia , Feminino , Imunofluorescência , Humanos , Imunoglobulina G , Masculino , Pessoa de Meia-Idade , Transplante HomólogoRESUMO
The influence of blood transfusions, HLA, A and B, DR matching was studied in adult patients transplanted in one centre. The conclusions were: 1. Pre-transplant blood transfusion(s) are a prerequisite for graft acceptance. 2. In transfused patients with no HLA A and B mismatch, there is only 8% graft loss due to irreversible rejection. 3. In transfused patients with a functioning graft after six months, a decrease in the number of reversible rejection crises is observed in patients with no HLA A and B mismatch or with identity for HLA B7 or HLA B8. 4. Identity for HLA B7 or B8 also gives a higher chance of a late onset of the first rejection crisis.
Assuntos
Transfusão de Sangue , Sobrevivência de Enxerto , Antígenos HLA , Transplante de Rim , Especificidade de Anticorpos , Cadáver , Ligação Genética , Rejeição de Enxerto , Teste de Histocompatibilidade , Humanos , Transplante HomólogoRESUMO
Sera of 97 consecutive transplant recipients were studied for the presence of antibodies directed against their renal allografts. A highly significant correlation (p less than 0.001) was found between irreversible rejection and donor-specific endothelial antibodies (EAb). EAb reacted not only with the endothelium of peritubular capillaries and venules, but also with glomeruli. Absorption of EAb to platelets, B- or T-lymphocytes did not remove its EAb activity or its cytotoxicity for monocytes. Furthermore, it was shown with a panel of randomly chosen donor kidneys, that EAb are directed against a polymorphic system of endothelial-monocyte antigens, which is unrelated to HLA-A, -B, -C or -D.
Assuntos
Anticorpos , Transplante de Rim , Sítios de Ligação de Anticorpos , Endotélio/imunologia , Rejeição de Enxerto , Humanos , Imunoglobulina G , Isoanticorpos , Rim/imunologia , Glomérulos Renais/imunologia , Monócitos/imunologia , Polimorfismo Genético , Transplante HomólogoRESUMO
A prospective study has been carried out in rhesus monkeys to investigate the influence of blood-transfusions on kidney allograft survival. Unrelated animals matched for 2 or 3 antigens of the A and B locus of the major histocompatibility complex were given five consecutive blood-transfusions before transplantation and received conventional immunosuppressive treatment. Transfused recipients showed a four-fold increase in mean survival time compared with the non-transfused controls. These results may contribute to a change of policy regarding blood-transfusions in transplant patients.
