SEVENTEEN CONSECUTIVE SUCCESSFUL ONE-HAPLOTYPE-MATCHED LIVING RELATED FIRST RENAL TRANSPLANTS USING DONOR-SPECIFIC BLOOD TRANSFUSIONS

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Abstract
A donor-specific transfusion (DST) protocol was carried out in 25 human recipients obtaining kidneys from live-related 1-haplotype-disparate high stimulating mixed lymphocyte culture (MLC) donors. The protocol consisted of the recipient receiving a transfusion of 200 ml of donor whole blood every 2 wk for a total of 3 transfusions. Before and after each transfusion and just before transplantation, recipient blood samples were tested for cytotoxic antibody studies against a random panel of 30 normal persons, in addition to donor-recipient crossmatches. Patients were followed for a minimum of 8 mo. and a maximum of 24 mo., with a mean followup of 14 mo. All of the 17 primary transplants performed were successful. Three 2nd transplants were performed. Two 2nd graft recipients rejected their transplants, while one was successful. Three patients of 25 developed either T-warm- or B-warm-positive crossmatches, while 2 patients who completed the study with negative crossmatches were not transplanted because of donor withdrawal following transfusions. Rejection episodes occurred infrequently, but when present, occurred early in the postoperative period (2nd or 3rd day). Only 6 of 25 subjects developed greater than 10% B-warm or T-warm circulating cytotoxic antibodies. Six of 8 subjects who entered the study with greater than 10% cytotoxic antibodies had diminishment in the strength of their antibody response after the DST. No patient was rendered untransplantable by the development of large numbers of cytotoxic antibodies. DST appears to be a highly successful technique for primary living related donor transplants in subjects who are 1 haploid identical but with nonidentical stimulating MLC indices.