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SEROTYPING FOR HOMOTRANSPLANTATION. VII. SELECTION OF KIDNEY DONORS FOR THIRTY‐TWO RECIPIENTS *
Author(s) -
Terasaki P. I.,
Vredevoe D. L.,
Mickey M. R.,
Porter K. A.,
Marchioro T. L.,
Faris T. D.,
Starzl T. E.
Publication year - 1966
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1966.tb12873.x
Subject(s) - public health , preventive healthcare , medicine , annals , surgeon general , family medicine , gerontology , history , pathology , classics
An attempt was made to select donors for human kidney transplantation on the basis of lymphocyte antigen matching. Compatibility was assayed by reactions of individual antisera on donor and recipient lymphocytes, as well as by matching on the basis of the six recognized leukocyte groups. The donor judged to be the best match was chosen from pools of related and unrelated donors. Although the choice was often limited, a group of donors was selected which, as a whole, was slightly more compatible than that achieved by random matching. Mismatches which were extremely high or from group 6 were avoided whenever possible. Eighteen transplants were done from related donors: sixteen of these recipients lived for at least 4 months postoperatively; three more died after 1012, 812 and 8 months. Thirteen of the original 18 patients are still alive, 6, after 4 to 8 months, four, after 8 to 21 months and three, after more than one year. This represents a slight improvement over the first unmatched Denver series treated 2 to 312 years ago. Of the 14 recipients in the present series who received kidneys from matched unrelated donors, ten lived for more than 4 months; two more died after 5 and 10 months respectively. Eight of the original patients are still alive with a minimum follow-up of 612 months; four of these patients are surviving 9 to 12 months after operation, and the other three, more than one year. These results are improved over that of an original nonselected series of unrelated homotransplants performed in Denver. Furthermore, the survival curve in these nonrelated donors and recipients now approximates that which was obtained in the past Denver experience with randomly selected related donors. Because of the relatively small numbers involved, however, this improvement is not statistically significant. Pathological studies of the kidneys from the recipients who died were compared to the kidneys of the dead recipients of the first Denver series in which donors were randomly selected. Acute vascular lesions which result from severe rejection were less frequent in this series as compared to the earlier un-matched series. It was concluded that coincidental to matching for provisional leukocyte types, an improved early clinical outcome of transplantation was obtained with respect to survival and minimization of pathologic changes associated with rejection. Whether the improvements are attributable to the matching procedure or to other unrecognized factors in the clinical management of the patients could not be determined.