Stored blood - an effective immunosuppressive method from unrelated donors: an 11-year follow-up

Thirty-seven patients were submitted to kidney trasnplantation after transfusion at 2-weeck intervals with 4-week stored blood from their potential donors. All patients and donors were typed for HLA-A-B and DR antigens. The patients were also tested for cytotoxic antibodies against donor antigens before each transfusion. The percentage of penel reactive antibodies (PRA) reative antibodies (PRA) was determined against a selected panel of 30 cell donors before and after the transfusions. The patients were immunosuppressed with azathioprine and prednisone. Rejection crises were treated with methylprednisolone. The control group consisted of 23 patients who received grafts from an unrelated donor but who did not receive donor-specific pretransplant blood transfusion. The incidence and reversibility of rejection episodes, allograft loss caused by rejection, and patient and graft survival rates were determined for both groups. Non-parametric methods (chi-square and Fisher tests) were used for statistical analysis, with the level of significance set at P<0.05. The incidence and reversibility of rejection crises during the first 60 post-transplant days did not differ significantly between groups. The actuarial graft and patient survival rates at five years were 56 percent and 77 percent, respectively, for the treated group and 39,8 percent and 57.5 percent for the control group. Graft loss due to rejection was significantly higher in the untreated group (P = 0.0026) which also required more intense immunosuppression (P = 0.0001). We conclude that tranfusions using stored blood have the immunosuppressive effect of fresh blood transfusions without the risk of provoking a widespread formation of antibodies. In addition, this method permits a reduction of the immunosuppressive drugs during the process with-out impairing the adequate funsctioning of the renal graft.

Irradiacao endolinfatica. Metodo util para imunessupressao em transplante renal. / Endolymphatic irradiation. A useful method for immunosuppression in renal transplantation

Foi analisado tardiamente a evolucao clinica e o destino do enxerto renal em 24 pacientes (grupo I) que receberam injecao endolinfatica do 131I como medida imunessupressora pre-transplante. O grupo-controle (grupo II) constituiu-se de 24 pacientes nao irradiados e comparaveis ao grupo I quanto a idade, sexo, diagnostico de doenca primaria, tipo de doador e terapia imunessupressora. Diferenca significativa entre os dois grupos foi encontrada com relacao a incidencia e reversibilidade das crises de rejeicao nos primeiros 60 dias pos-transplantes; perda de rim em rejeicao e dose de manutencao de azatioprina. Os autores concluem que o metodo, alem de inocuo, tem acao imunessupressora prolongada, podendo ser indicado para receptores de rim de cadaver, sobretudo os casos que apresentam a cross-match positivo contra antigenos HLA para painel