Histocompatibility in cardiac transplantation with particular reference to immunopathology of positive serologic crossmatch.
Cardiac allografting was carried out in 33 patients during the past 2 years. Twenty-one (64%) of the patients are alive and others lived for different periods after transplantation. The number of HLA-AB and HLA-DR antigens matched or mismatched was not significantly different between the surviving and deceased patients. However, 100% (4 of the 4) of the patients with a positive serum crossmatch with donor T lymphocytes are deceased as compared to the 25% (7 of the 28) mortality rate for crossmatch-negative patients. All four of the deceased patients with a positive crossmatch had demonstrable deposition of immunoglobulins in the capillaries of the donor heart at autopsy, whereas no immunoglobulin or fibrinogen deposition was seen in the hearts of crossmatch-negative patients. Three of the four patients with positive crossmatches had sera cytotoxic to lymphocytes of more than 25% of the persons, of a 42 member panel, whereas in the remaining one the serum was cytotoxic to less than 5% of the panel members. In crossmatch-negative patients, the sera were cytotoxic to less than 20% of the panel members with one exception. The relevance of cytotoxic antibodies to lymphocytes of panel members, crossmatch, and tissue deposition of immunoglobulins is discussed.
D000328:Adult; D000961:Antilymphocyte Serum / Q000494:pharmacology; D009202:Cardiomyopathies / Q000276:immunology / Q000473:pathology / Q000628:therapy; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006680:HLA Antigens / Q000032:analysis* / Q000276:immunology; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens; D016027:Heart Transplantation; D000949:Histocompatibility Antigens Class II / Q000032:analysis; D006650:Histocompatibility Testing; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000276:immunology / Q000473:pathology*
D000961:Antilymphocyte Serum; D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens; D000949:Histocompatibility Antigens Class II; D007075:Immunoglobulin M; D005340:Fibrinogen