IMMUNOLOGICAL STUDIES OF ELUATES OF 83 REJECTED KIDNEYS Screening of Antibodies Directed Against T and B Lymphocytes, Glomerular and Tubular Basement Membranes, DNA, and IGG

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Abstract
Acid eluates of Ig obtained from 83 human kidney allografts which failed for various reasons were studied. Eluates and IgG purified from eluates were screened in all cases on panel lymphocytes and in 15 cases on donor lymphocytes. Antiglomerular basement membrane (GBM), antitubular basement membrane (TBM), anti-DNA and anti-IgG antibodies were studied. Kidneys were divided into groups: 1 (n = 17), never-functioning grafts; 2 (n = 34), grafts which worked initially but were removed within 3 mo.; 3 (n = 24), chronically rejected grafts; 4 (n = 8), kidneys removed for obvious nonimmunological reasons; and 5 (n = 9), cadaveric donor kidneys not grafted for anatomical reasons (controls). Respectively, 55, 62, 75 and 0% of the eluates in groups 1, 2, 3, and 4 and 5 contained IgG. chronically rejected grafts contained the highest amount of IgG. Cytotoxic anti-T lymphocyte antibodies were found, respectively, in 15 and 13% of IgG of groups 2 and 3, but were totally absent in group 1. Anti-B lymphocyte antibodies were more frequent: respectively, 47, 21 and 38% in groups 1, 2 and 3. Nonrejected and control kidneys completely lacked anti-T and B lymphocytes. Presence of cytotoxic antibodies was significantly correlated with the presence of IgG in eluates. Parallel studies on recipient sera and IgG eluted from corresponding rejected grafts on donor lymphocytes were performed 15 times and showed a better concordance for the presence of cytotoxic anti-B lymphocytes than for anti-T lymphocytes. Clear anti-HLA-AB, or HLA-DR specificites were seldom assigned. Among 79 eluates tested for anti-IgG, 33 were positive. Most reacted with the IgG3 class and belonged to groups 2 (16 of 32) and 3 (9 of 19). In 8 recipients with serum anti-IgG, corresponding eluates were 5 times as positive with the same anti-Rh pattern. Of 79 eluates, 23 gave direct uncoated RBC [red blood cell] agglutination, probably attributable to anti-I autoantibodies. Anti-GMB and anti-TBM were frequently detected in low amounts, but 3 of 11, 4 of 17 and 1 of 13 were strongly positive in groups 1, 2 and 3. Only 2 eluates displayed strong anti-DNA activity. IgG and cytotoxic antilymphocytes may be related to graft injury. Anti-IgG and/or low amounts of anti-GBM, anti-TBM or anti-DNA were also observed but seem mainly to represent suitable immune complex conditions rather than direct pathogenic factors.