ABSTRACT
Eighty-one donor-recipient pairs were evaluated prior to renal transplantation to obtain histocompatibility profiles. Standard tissue typing was used to detect serologically defined A and B locus antigens, and mixed lymphocyte cultures were employed to detect lymphocyte defined antigens. Results of both tests were correlated with each other and with allograft rejection. It was shown that as serologically defined histocompatibility at the A and B loci decreases, both the rate of graft rejection and the percentage of high mixed lymphocyte culture stimulation increase. Within each serologically defined category were found patients with a high and a low stimulation index in mixed lymphocyte culture. Regardless of the degree of serologically defined histocompatibility, patients with a high stimulation index had a statistically significant higher graft rejection rate than did patients with a low stimulation index. It appears that the mixed lymphocyte culture assay is a method superior to standard tissue typing in predicting renal allograft rejection with related donors, and therefore all potential donors for renal transplantation should be screened, utilizing the mixed lymphocyte culture technique.
Subject(s)
Histocompatibility Antigens/analysis , Kidney Transplantation , Lymphocyte Culture Test, Mixed , Transplantation Immunology , Adolescent , Adult , Child , Female , Graft Rejection , Histocompatibility Testing , Humans , Male , Middle Aged , Transplantation, HomologousABSTRACT
Seventy-four recipients of related donor renal allografts were tested for the presence of cellular immunity to specific donor lymphocyte antigens using the direct migration inhibition factor (MIF) assay. Responses on the assay fell into one of the following three statistically distinct groups: (1) greater than 20% inhibition of macrophage migration, (2) nonresponsiveness, +/- 10% of control migration, and (3) greater than 12% stimulation of macrophage migration. Migration stimulation was shown to be reproducible and to correlate well with a very benign post-transplant clinical course. The production of migration stimulatory factor appears to be an immunological response analagous to the production of migration inhibition factor.
Subject(s)
Kidney Transplantation , Macrophage Migration-Inhibitory Factors/biosynthesis , Female , Histocompatibility , Humans , Immunity, Cellular , Male , Transplantation, HomologousABSTRACT
Results of mixed lymphocyte culture reactions and tissue typing were correlated with the clinical courses of recipients of living related donor renal allografts. Forty-nine patients tested by the mixed lymphocyte culture technique were divided into two response groups: stimulation index greater than 5 and stimulation index less than 5. Seventy patients were tested by standard tissue typing methods and were categorized by the number of misstimulation in mixed lymphocyte culture than with mismatched antigens, suggesting that lymphocyte-defined histocompatibility is more important than serologically defined histocompatibility in selecting the best possible allograft donor.
Subject(s)
Graft Survival , Histocompatibility Testing , Kidney Transplantation , Graft Rejection , HLA Antigens , Humans , Kinetics , Lymphocyte Culture Test, Mixed , Transplantation, HomologousABSTRACT
Sera samples from eight different groups of patients were tested for the presence of circulating antibody (IgG) directed against vascular endothelial cell antigens. The indirect immunofluorescent method which used either whole blood vessels or single endothelial cells as targets was compared to lymphocytotoxicity panels. The indirect immunofluorescent antibody test (IFA) consistently detected antibody in sera samples which were negative for lymphocytotoxic activity, and the presence of IFA antibody to vascular endothelial cells had a much better correlation with both clinical course and renal allograft rejection than did the lymphocytotoxicity panels. Single vascular endothelial cells appeared to be a more sensitive target for the detection of IFA antibody than did whole vessels. Preliminary absorption studies suggest that cell-specific as well as HL-A antigens play a role in the immunological response to vascular endothelial cells.
Subject(s)
Antibodies/analysis , Blood Vessels/immunology , Graft Rejection , Kidney Transplantation , Cytotoxicity Tests, Immunologic , Endothelium/immunology , Female , Fluorescent Antibody Technique , History, 18th Century , Humans , Immunoglobulin G/analysis , MaleABSTRACT
Seventy-one recipients of related donor renal allografts were tested for cellular immunity with the direct migration inhibition factor assay. Patients were divided into three groups on the basis of their responses in the assay. It was shown that all patients whose lymphocytes stimulated macrophage migration in vitro experienced more benign clinical courses than did those patients whose lymphocytes inhibited macrophage migration in vitro. The significance of a correlation between in vitro macrophage stimulation and clinical course is discussed.
