Anti-erythrocyte antibodies, leukocytotoxins and human renal allograft survival.

ABO blood group compatibility is generally required for successful human kidney transplants and new data suggest donor-recipient incompatibility for the Lewis or multiple minor blood groups is detrimental. This is of special importance in the setting of liberal transfusions prior to transplant. To assess the impact of immunizing exposure to disparate blood groups of ABO-matched transfusions and kidney transplants, we studied the interrelationships of anti-erythrocyte antibodies, leukocytotoxins and graft survival in 42 kidney transplant recipients. Three hundred forty-four sera were screened for anti-erythrocyte antibodies using standard hemagglutination techniques and leukocytotoxins, using the antiglobulin method. Statistical analysis by computer used a 2 x 2 x 2 contingency table with model fitting. Only 13 of 42 patients had anti-erythrocyte antibodies at some time: anti-I (4); anti-Kell (1); cold panagglutinin (7); unidentifiable agglutinin (1). Of 42 patients, 16 had no detectable leukocytotoxins. By computer analysis, immunizations to blood group and HLA antigens were independent phenomena. Analysis showed that leukocytotoxins, but not anti-erythrocyte antibodies, were associated with poor graft survival. A computer generated probability of graft survival by antibody status is presented. We conclude that immunization to blood group antigens is not common, is largely non-specific, and is not detrimental to kidney graft survival.

Pooled sera for cytotoxicity testing: accurate, time- and cost-effective preliminary crossmatches.

To conserve sera, reduce technologist time and facilitate distribution of kidneys to the most likely recipient from groups of highly sensitized patients, we studied the feasibility of using pooled sera in preliminary crossmatches. From 16 chronic renal failure patients, 275 sera were studied against fresh cell panels from 24 to 35 donors. Using the antiglobulin crossmatch technique, sera were studied individually, in consecutive pools of five and in consecutive pools of 10. Reactions of component sera were assessed on a cell-by-cell comparison with their pools of five and 10 sera. Crossmatches performed with pools of five sera and pools of 10 sera detected the same cytotoxic reactions as did their component sera in 97.6% and 97.8% of the reactions, respectively. We conclude that 10 sera can be pooled so that preliminary crossmatch testing of all positive sera of all theoretically potential allograft recipients can be accomplished with accuracy and efficiency, even in the larger regional distribution centers.

A study of HLA-A, B, C, and DR specificities in pigeon breeder's disease.

The frequencies of HLA-A, -B, and -C antigens were determined among 51 symptomatic pigeon breeders, 102 asymptomatic pigeon breeders, and 100 normal blood donors. The HLA-DR specificities were also studied in 32 symptomatic and 29 asymptomatic pigeon breeders. All subjects were white. Symptomatic subjects were defined by the development of respiratory symptoms or decreased pulmonary function after aerosol challenge with pigeon serum. Asymptomatic subjects were comparably exposed to pigeons but had no pulmonary signs or symptoms after aerosol challenge. No significant association was found between any of the tested HLA specificities and pigeon breeders. This lack of association and the observed paucity of multiplex families indicate that HLA complex genetic factors tested in this study do not favor the development of pigeon breeder's disease in exposed persons.