Renal allograft recipient immunomodulation by concomitant immunosuppression and donor-specific transfusions.
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%. One hundred thirty-five of 140 nonsensitized patients underwent renal transplantation from the specific blood donor and 56% have never experienced a rejection episode. The allograft survival rate at 2 years (93%) and 7 years (87%) is significantly better (P less than .01) than our historical experience with one-haplotype living-related transplants at 2 years (68%) and 7 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%) argue for a modification of the immunologic response, perhaps by clonal deletion, rather than a selecting-out process as the mechanism for improved allograft survival.
Anderson
C B
CB
Washington University School of Medicine, St Louis, MO.
Jendrisak
M D
MD
Flye
M W
MW
Hanto
D W
DW
Anderman
C K
CK
Rodey
G E
GE
Sicard
G A
GA
D001379:Azathioprine / Q000627:therapeutic use*; D001803:Blood Transfusion; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D006650:Histocompatibility Testing; D006801:Humans; D007114:Immunization; D016030:Kidney Transplantation; D008297:Male; D009928:Organ Specificity; D011300:Preoperative Care; D014019:Tissue Donors; D065227:Transfusion Reaction
D001379:Azathioprine