Development of lymphocytotoxic antibodies in hemodialysis patients

Cold and warm antibodies and graft survival in kidney allograft recipients

Serial serum samples from 35 renal allograft recipients were screened for cold and warm cytotoxic antibodies using a two-stage microlymphocytotoxicity test with three incubation temperatures. Both cold and warm antibodies were reactive at 22 degrees C. The critical temperatures which distinguished the two classes of antibodies were 15 degrees C and 37 degrees C. Cold antibodies were detected in sera from 15 patients, 10 patients had warm antibodies, and the remaining 10 had a mixture of cold and warm antibodies. All the patients were cytotoxin-positive after transplantation, although not all had preformed lymphocytotoxins. At one year 14 of the patients with cold autoantibodies had functioning grafts, but only 3 of the 10 patients with warm antibodies had kidneys functioning. This difference was statistically highly significant. There was no difference in graft survival among patients with warm antibodies and those with a mixture of cold and warm antibodies.

Kidney transplantation: Improvement in patient and graft survival

Patient and graft survival were reviewed in a series of 249 kidney transplants done from 1963 to March 1973. Patient survival was calculated by the life table method for the periods 1963-1970, and 1970-1973, since in 1970 a formal Kidney Center was established and mortality rates changed. Graft survival was analyzed in terms of donor source, HL-A matching and immune responsiveness to HL-A antigens. Three-year predicted mortality for cadaver kidney recipients was 62% between 1963 and 1969 (42 patients) and 8% between 1970 anid 1973 (67 patients). Similar predicted mortality for related living donors was 30% between 1963 and 1969 (52 patients) and 14% between 1970 and 1973 (85 patients). Mortality has continued to decrease and there has been only one death in the last 87 consecutive transplants, including 57 consecutive cadaver transplants. Oneyear predicted kidney survival for the 10-year period is 44% for cadaveric, 60% for non HL-A identical related living and 90% for HL-A identical sibling donors. In the cadaver group, those sharing 2 or more HL-A antigens had the same kidney survival as the non HL-A identical related living donor grafts. Since cadaver graft recipients are on dialysis for a longer period of time, immune responsiveness can be detected by their response to blood transfusions, whereas this determination could not be made in our related living donor group. Non-responsive cadaver kidney recipients had 80% one year kidney survival. We conclude that transplant mortality can be reduced to less than 10% by the Center approach to treatment of renal disease, dialysis does not adversely affect future transplantation, and excellent (80%) kidney survival can be expected in properly selected cadaver graft recipients.