[Test of differential anti-T and anti-B lymphocyte compatibility in renal transplantation. A partial solution to the problem of hyperimmune patients].
In view of their beneficial effect on the functional survival of transplanted kidneys, pretransplantation blood transfusions of haemodialysed patients have become routine procedure. At the same time, the number of hyperimmune patients awaiting transplantation has been increasing, as these are often excluded on account of positive cross-match. Cross-matching is usually done by testing recipients' sera against total donor's lymphocytes, so that positive cross-match due to specific anti-T cell cytotoxic antibodies cannot be differentiated from that due to anti-B cell antibodies. Differential anti-T cell and anti-B cell cross-matching showed no significant difference between the survival of 34 transplants with B cell-positive cross-match and that of 126 transplants with B cell-negative cross-match (67% and 60% respectively at 12 months). It also showed that anti-B cell antibodies had no adverse effect on the survival of transplants. The presence of antibodies or auto-antibodies with optimal cytotoxicity at 4 degrees C did not appear to correlate with a significantly longer transplant survival as compared to other transplanted patients. Finally, a high degree of a anti-T cell immunization or a strongly positive B cell cross-match on transplantation day did not seem to jeopardize transplant survival in a B-cell-positive cross-match population of transplanted patients. The differential cross-matching method has made it possible to successfully transplant a substantial number of hyperimmune patients: at least 62% of patients with B cell-positive cross-match also had positive total lymphocyte cross-match which would have precluded renal transplantation.
D000961:Antilymphocyte Serum / Q000032:analysis*; D001323:Autoantibodies / Q000032:analysis; D001402:B-Lymphocytes / Q000276:immunology*; D003080:Cold Temperature; D006085:Graft Survival; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation; D006435:Renal Dialysis; D013601:T-Lymphocytes / Q000276:immunology*; D065227:Transfusion Reaction
D000961:Antilymphocyte Serum; D001323:Autoantibodies
Epreuve de compatibilité différentielle anti-T anti-B lymphocyte dans la transplantation rénale. Une solution partielle au problème des malades hyperimmunisés.