Powerful effect of HL-DR matching on survival of cadaveric renal allografts

Matching for HLA-DR antigens seems to be an effective method of improving the survival rate of cadaveric donor renal allografts; this was shown in the analysis of 190 cadaver transplants in one unit. Patients receiving kidneys well-matched for HLA-DR (no incompatibilities) had a significantly better survival rate (85% at 1 year) than patients with 1 or 2 incompatibilities (64% and 56% respectively, at 1 year). This high survival rate of the DR matched grafts was not due to coincidental better matching of the HLA-A and B antigens. DR matching seems to improve graft survival even in patients who have never been transfused or not. Matching for the limited number of DR antigens mostly with a relatively high antigen frequency should simplify the matching procedure for selection of donor-recipient pairs in cadaveric transplantation.

Peroperative blood-transfusion improve cadaveric renal-allograft survival in non-transfused recipients. A prospective controlled clinical trial

The effect of peroperative transfusion was studied in 27 patients who had never had a blood-transfusion or been pregnant and who were receiving their first cadaver renal allograft. 13 patients in the treatment group were given 2 units of whole stored blood at transplantation, whereas 14 patients in the control group were given no blood. Actuarial analysis after 2 years showed a graft survival of 85% at 1 year in the treated group compared with 34% at 1 year in the control group (p = 0.03). Transfusion of non-transfused patients during transplantation may be as effective as pregraft transfusion.

HLA-A, B and C and HLA-DR antigens in intrinsic and allergic asthma

Some 103 patients with asthma and 100 healthy volunteers have been typed for HLA-A, B and C and HLA-DR antigens. The 103 patients consisted of thirty-three with intrinsic asthma, thirty-four with extrinsic asthma, and thirty-six known to have precipitins to Aspergillus fumigatus. No increase in frequency of any of the A, B, C, or DR antigens was found to be significant after correction for the number of comparisons was made. However certain trends comparable to findings in other immunopathic disorders were noted. For example B12 was increased in the allergic asthmatics (46 vs 29% controls) and it is suggested that B12 is associated with the ability to produce the IgE antibodies. A3/B7/DRw2 (which are in linkage disequilibrium) all show a decreased frequency in intrinsic asthma (24, 12 and 9% vs 32, 26 and 24% respectively in controls). Finally B8 and DRw3, which showed a moderate increase in frequency in all three groups of asthmatics, were found in five of seven patients with low atopy but persisting antibodies to A. fumigatus. Further detailed studies of these asthmatic subgroups is warranted.

Calcium transport by pigeon erythrocyte membrane vesicles

Membrane vesicles from pigeon erythrocytes show a rapid, ATP-dependent accumulation of 45Ca2+.Ca2+ accumulation ratios greater than or approximately equal to 10(4) are readily attained. For ATP-dependent Ca2+ uptake, V is 1.5 mmol.1(-1).min(-1) at 27 degrees C (approx. 0.9 nmol.mg-1 protein.min-1), [Ca2+]1/2 is 0.18 microM, [ATP]1/2 is 30--60 microM, the Ca2+ uptake rate depends on [Ca2+]2 and the dependence of uptake rate on ATP concentration implies strong ATP-ATP cooperativity. The Arrhenius activation energy is 19.1 +/- 1.4 kcal/mol and the pH optimum is approx. 6.9.

Development of donor-specific B lymphocyte antibodies after renal transplantation. No correlation with graft outcome

Serum samples from 66 recipients of first cadaver donor renal transplants were screened for cytotoxic antibodies to normal T and B lymphocytes and B lymphocytes from chronic lymphocytic leukaemia patients. In addition, the sera of 44 patients were tested with the B lymphocytes of their respective donors. Donor-specific antibodies were found in 10 of 16 (63%) recipients who had lost their transplant within 2 months, and in 17 of 28 (61%) patients with functioning transplants at 2 months. No correlation was found between the development of B lymphocyte antibodies (either against the panel or the donor) and the onset of an acute rejection episode. In the 17 patients with a successful transplant and donor-specific antibodies, six (35%) had not experienced a rejection episode and another seven patients developed their antibodies after the appearance of the first rejection episode. Thus, our results show that the appearance of donor-specific B lymphocyte antibodies after transplantation is not indicative of graft failure or predictive of acute rejection episodes. However, the common occurrence of such antibodies raises questions concerning the nature of the antigenic stimulus, the specificity of the antibodies, and their role (if any) in transplantation.

Results from a new renal transplantation unit

158 kidneys, 9 from living related donors and 149 from cadavers, have been transplanted in the first 42 months of the establishment of a transplant unit at Oxford. Patients' ages ranged from 11 to 56 (mean 35) years. Azathioprine and prednisolone alone were used for immunosuppression, and a minimum-transfusion policy was in operation throughout. After cadaveric transplantation actuarial patient-survival is 70% and 68%, respectively, at the same intervals. 85% of patients who had a functioning graft are fully rehabilitated. Matching for HLA-DR, pregraft blood-transfusions, and the finding that a transplant could be performed in the presence of a positive B-cell crossmatch have proved to be the most significant of the many factors examined both prospectively and retrospectively. The function of the unit is based on dialysis and transplantation for all patients in end-stage renal failure, with transplantation being considered the first line of treatment for patients under the age of 56. The results of transplantation reported here, which have been achieved with conventional immunosuppressive therapy and minimum-transfusion policy, might be considered a standard against which modifications of the practice of renal transplantation can be compared.

HLA in primary atrophic hypothyroidism and Hashimoto goitre

The prevalence of HLA-B8 was found to be significantly increased in patients with primary atrophic (no goitre) hypothyroidism, but not in goitrous patients with Hashimoto thyroiditis, whether euthroid or hypothroid. There was no correlation between the occurrence of HLA-B8 and the presence of titres of thyroid antibodies at diagnosis or their persistence for at least three years after diagnosis.

Renal transplantation in the presence of a positive crossmatch

Eighteen renal transplants have been performed prospectively in the presence of a positive serologic crossmatch against donor B lymphocytes. Four transplants have failed, three from rejection and one from renal artery thrombosis. Fourteen are functioning at 3-17 months after transplant. Thus, a renal transplant may be performed in the presence of a positive B-cell crossmatch in most instances without immediate graft rejection.

Matching for B-cell antigens of the HLA-DR series in cadaver renal transplantation

Stored and fresh lymphocytes from 84 donors and recipients of cadaveric renal allografts have been retrospectively typed for 7 HLA-DR antigens. The match between donor and recipient was graded as 2, 1, or 0 identities. Graft function was assessed by (i) failure or success at 3 months, (ii) serum-creatinine at 3 and 6 months, and (iii) the number of rejection episodes occurring within 3 months. All 4 recipients with 2 identities had good 3-month function, and all are still functioning at 5--19 months. Recipients with 1 identity had both a higher success-rate and better quality of function than those with 0 identities. Although the differences do not reach significance, a continuing prospective study of HLA-DR matching is justified, with particular emphasis on performing transplants where two DR antigens are shared between donor and recipient.

Reactivity of autolymphocytotoxic antibodies from dialysis patients with lymphocytes from chronic lymphocytic leukemia (CLL) patients

Autolymphocytotoxic antibodies are found commonly in dialysis patients and these autoantibodies may be directed against T and B lymphocytes or just B lymphocytes. However, these autoantibodies react with a low frequency or not at all against chronic lymphocytic leukemia cells, and are not absorbed by autologous erythrocytes. Thus, a number of positive crossmatches between donor and recipient may be attributable to autoantibodies. Six renal transplants have been carried out in the presence of such a positive crossmatch against donor B lymphocytes, including one against donor T lymphocytes, with a successful graft outcome. Thus, the indications for renal transplantation in the presence of a positive crossmatch between donor and recipient are becoming better defined.

Development of Rh-specific maternal autoantibodies following intensive plasmapheresis for Rh immunisation during pregnancy

Two cases of autoantibody formation following large volume plasmapheresis for rhesus immunisation during pregnancy are described. In each case the autoantibody was directed against the Rh complex but showed a preference for G-positive cells. It is postulated that repeated plasmapheresis in the presence of persistent antigenic stimulation has removed a feedback inhibition of the immune response. The specificity of the alloantibody has broadened resulting in cross-reactivity against self-antigens. The possible implications of these cases in relation to autoimmunity are discussed.

Renal transplantation and B-cell cross-matches with autoantibodies and alloantibodies

Of 51 cadaveric kidneys transplanted between June, 1976, and June, 1977, 18 were transplanted in the presence of a positive cross-match against the donor's B lymphocytes. 11 of these positive cross-matches were due to alloantibodies and 7 due to autoantibodies. Autoantibodies were defined not only on the basis of autoreactivity with B lymphocytes but also by their absent or restricted reactivity with lymphocytes from patients with chronic lymphocytic leukaemia. Transplants in 8 of 11 patients with a positive alloantibody-B-cell cross-match and in 6 of 7 patients with a positive autoantibody-B-cell cross-match were successful at 3 months. These success-rates were no different from those found in patients with a negative B-cell cross-match. Thus, renal allografts may be performed with a reasonable assurance of success in the presence of a positive B-cell cross-match whether due to autoantibodies or to alloantibodies.

Correlation of HLA and thyroid antibodies with clinical course of thyrotoxicosis treated with antithyroid drugs

The prevalence of HLA-B8 in thyrotoxic (Graves' disease) patients who relapsed after withdrawal of antithyroid drugs was high (69%) compared with that in patients who remained in remission (40%) and in healthy controls (28%). B8-positive patients were 1-8 times more likely to relapse after withdrawal of drug therapy than B8-negative patients. The persistence of thyroid microsomal antibodies after withdrawal of therapy correlated significantly with the presence of HLA-B8. This association was more pronounced in patients who remained in remission. From this it might be assumed that B8 is also associated with the persistence of thyroid T.S.H. (thyroid-stimulating hormone) receptor stimulating antibodies. In view of these findings, it is suggested that patients who are thyrotoxic might be typed for HLA, and those who are B8-negative could be given a trial of long-term antithyroid drug therapy.

Renal transplantation and a positive serological cross-match

A renal transplant involving a recipient with a positive serological cross-match against donor lymphocytes generally results in hyperacute rejection of the graft. 13 cadaveric renal transplants were performed in recipients with a known positive serologic cross-match against donor B lymphocytes. 12 of these serological cross-matches were positive against donor blood, node, or spleen lymphocytes, but the reactivity was directed against donor B lymphocytes only. 3 transplants failed, 2 because of rejection and 1 because of renal-artery thrombosis. 10 transplants are functioning, 6 to 42 weeks after the operation. Of these 10 successful grafts, 3 had no acute rejection episodes, while 7 had an early acute rejection episode which responded to treatment. Histologically, the grafts showed a cellular rejection, similar to that in enhanced renal allografts in the rat. It is possible to transplant a kidney in a high-risk patient with a positive B lymphocyte cross-match with a low risk of failure. In addition active enhancement of the graft might sometimes occur.