THORACIC-DUCT DRAINAGE BEFORE AND AFTER CADAVERIC KIDNEY-TRANSPLANTATION

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  • 1 January 1979
    • journal article
    • research article
    • Vol. 149  (6) , 815-821
Abstract
Consecutive recipients [27] of cadaveric kidneys, including 5 with pre-existing warm cytotoxic antibodies, were treated with thoracic duct drainage before and after transplantation. Patients who had lymph drainage 26-58 days before transplantation had minor cytotoxic antibody responses after grafting, even if the antibodies were present before therapy. Only 1 of the 14 recipients had any rejection during the follow-up periods of 1-6 mo. There were 2 deaths. The 13 patients pretreated for 17-23 days exhibited stronger cytotoxic antibody responsiveness, and 5 of these recipients had significant rejections of which 4 were reversible. One of the latter 13 patients died. These clinical and immunologic studies established the value and defined the appropriate timing of preoperative thoracic duct drainage in kidney transplantation. They also directed attention to the rationale and the probable value of using other immunosuppressive methods for preparatory host conditioning instead of beginning such therapy at the time of transplantation.