Fetal tissue/organ transplant in HLA-randomized adult vascular subcutaneous axillary folds: preliminary report of 14 patients.
BACKGROUND
In the year 1902, the first successful experimental organ transplant, i.e., an autotransplant of a dog's kidney from its normal position to the vessels of the neck, which resulted in some urine flow, was performed in the Vienna Physiology Institute under the direction of Hofrath Exner by Dr. Emerich Ullman (1861-1937). Since then, the art of transplant surgery has come a long way in establishing itself as an important discipline with the support disciplines of immunology, molecular biology, etc., for the restoration of a failing organ. Today there is a major discrepancy in the demand and supply of organ grafts. The aim of the present study is to see whether fetal organ and tissue, with its intrinsic advantages of hypo-antigenicity, can survive in a HLA and sex-randomized host in a surgically prepared vascular subcutaneous axillary fold, without any immunosuppressive support. We have earlier reported two cases of fetal thymic transplant, collected from consenting mothers undergoing hysterotomy and ligation.


METHODS
Fourteen cases were recruited for the present study after thorough informed consent and approval by the Ethical Committee of the Project. Of these, five patients were suffering from advanced cancer, three from diabetic gangrene, three from ischaemic heart disease and three from rheumatoid arthritis, liver abscess and disc prolapse. The ages of the patients varied from 39 to 82 years. Six fetal thymuses, three fetal liver tissues, three fetal cardiac tissues, one fetal pancreas and one fetal lung tissue were transplanted. All the fetuses were dissected and the selected tissues/organs were transplanted within one to three minutes after collecting them from the consenting mothers undergoing hysterotomy and ligation. The fetal tissue graft was placed in a surgically prepared subcutaneous vascular axillary fold, 2x1 cm, under local anaesthesia in the consenting adult recipient. Sequential Hb, Tc, Dc, ESR were done to see the impact of the transplant on the host system. After one month, the transplanted fetal tissue was taken out by an elliptical incision and the tissue was processed for histological staining.


RESULTS
All the 14 patients tolerated the transplant procedure well. There was no fever, intractable pain or any other specific serious side-effect justifying removal of the transplant earlier. There was no discharge from the incision site and the healing and scar were by and large normal. There was no unusual leucocytosis or lymphocytosis. The serial histological study did not suggest features of transplant rejection.


CONCLUSIONS
Pregnancy and neoplasm are two outstanding examples of natural tolerance to homograft. In both cases, blocking antibody has an important role in the phenomenon of immunotolerance. From our experiments mentioned above transplantation and our earlier reported studies, we believe that the hypo-antigenic fetal tissue has distinct advantages over adult tissue for transplant purposes.
Bhattacharya
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Principal Investigator of the Project on Fetal Tissue Transplant in Adult Health and Disease, and Surgeon-Superintendent, Bijovygarh State Hospital, Calcutta, India.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D005260:Female; D016332:Fetal Tissue Transplantation; D005333:Fetus / Q000276:immunology*; D006680:HLA Antigens; D006321:Heart / Q000196:embryology; D016027:Heart Transplantation; D006801:Humans; D007108:Immune Tolerance; D008099:Liver / Q000196:embryology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D013950:Thymus Gland / Q000196:embryology / Q000637:transplantation; D014181:Transplantation Immunology
D006680:HLA Antigens