title: Concomitant immunosuppression and donor-specific transfusions prior to renal transplantation.
abstract: The induction of immunologic unresponsiveness to improve renal allograft survival was attempted in 151 patients by the pretransplant administration of donor-specific whole blood or buffy coat in conjunction with continuous Aza immunosuppression. All donor-recipient combinations were at least one-haplotype disparate and 21 were two-haplotype disparate. Presensitization was present in ten patients and attempts at desensitization were uniformly unsuccessful. Of the 151 nonpresensitized patients, transient sensitization occurred in 3% and permanent sensitization in 7%. Of 140 nonsensitized patients, 135 underwent renal transplantation from the specific blood donor and 56% have never experienced a rejection episode. The allograft survival rate at two years (93%) and seven years (87%) is significantly better (p less than .01) than our historical experience with one-haplotype living-related transplants at two years (68%) and seven years (59%). The low rate of sensitization (7%) has permitted almost all patients to undergo eventual renal transplantation from the specific blood donor. This and the low rate of early rejection (2%) argues for a modification of the immunologic response, perhaps by clonal deletion, rather than a selecting out process as the mechanism for improved allograft survival.
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: C B
authors.initials: CB
authors.lastname: Anderson
authors.forename: M D
authors.initials: MD
authors.lastname: Jendrisak
authors.forename: M W
authors.initials: MW
authors.lastname: Flye
authors.forename: D W
authors.initials: DW
authors.lastname: Hanto
authors.forename: C K
authors.initials: CK
authors.lastname: Anderman
authors.forename: G E
authors.initials: GE
authors.lastname: Rodey
authors.forename: G A
authors.initials: GA
authors.lastname: Sicard
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000276:immunology; D001803:Blood Transfusion; D002986:Clinical Trials as Topic; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D013601:T-Lymphocytes / Q000276:immunology; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D001379:Azathioprine