IMPROVED RENAL ALLOGRAFT SURVIVAL FOLLOWING DONOR-SPECIFIC TRANSFUSIONS

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Abstract
The essence of the clonal deletion model fo the donorspecific transfusion (DST) effect is synergy between DST-priming and post-transplant immunosuppresion. Using a sensitive kinetics assay of the mixed lymphocyte cluture (MLC) response to donor and third-party stimulators, we compared the responses of controls (nontransfused healthy individuals) with those of patients posttransplant (grup 1) or who had DST-tupe (<3d onset) rejection episodes (group 2). We found that group onset) rejection episodes (group 2). We found that group 2 patients had normal or above-normal MLC responses after DST plus azathioprine (AZA pretransplant treatment, but had a reduced/delayed posttransplant antidonor MLC following reversal of early rejections (P=.05 compared with controls). Groups 1 patients had a nonspecifically reduced MLC after DST+AZA treatment (P<.02 compared with controls), while posttransplant MLA responses showed a return to normal (pretransfusion) levels. These data suggest a synergy of DST with immunosuppressive drug that induced MLC hyporesponsiveness, but only in patients who received antilymphoblast globulin or a sustained high dose immunosuppression in the early posttransplant period.