Book reviews

Click on the link to view the book reviews.SAMJ 45(6

Thoracic duct drainage before and after cadaveric kidney transplantation

Twenty-seven consecutive recipients of cadaveric kidneys, including five with pre-existing warm cytotoxic antibodies, were treated with thoracic duct drainage before and after transplantation. Fourteen patients who had lymph drainage for 26 to 58 days before transplantation had minor cytotoxic antibody responses after grafting, even if the antibodies had been present before therapy. Only one of the 14 recipients had any rejection during the follow-up periods of one to six months. There were two deaths. The 13 patients pretreated for 17 to 23 days exhibited stronger cytotoxic antibody responsiveness, and five of these recipients had significant rejections of which four were reversible. One of the latter 13 patients died. These clinical and immunologic studies have established the value and have defined the appropriate timing of preoperative thoracic duct drainage in kidney transplantation. They have 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

Interspecies reactivity and intraspecies specificity of antilymphoid globulin

Horse antihuman and antidog antilymphocyte globulins were shown to possess leukoagglutinating antibodies when tested against the white cells from a number of other divergent species. In addition, the white cells of individuals within the species against which immunization was originally conducted were variably affected by the immune globulin. The latter observation suggests that these globulins could be more effective in some cases than in others if they were used therapeutically for their immunosuppressive qualities. © 1967

Renal transplantation at the university of Colorado

From March 1962 to April 1963, 118 patients were treated with renal transplantation, 3 with kidneys from identical twins, 9 with cadaveric homografts, and 106 with homografts from volunteer donors. Sixty-two of the patients are still alive after nine months to almost five years. The only completely satisfactory group was that of the identical twin recipients. The results after homotransplantation have not materially improved during this time despite the acquisition of increased experience, adjustments of timing and dosage of azathioprine and prednisone, and attempts to identify biologically suitable donors in advance of operation by tissue typing. It is suggested that an impasse has been reached, beyond which further reduction in mortality and morbidity will depend primarily upon the effective application of new immunosuppressive techniques. © 1967 by The Williams and Wilkins Co

Serotyping for homotransplantation V. Evaluation of a matching scheme

An attempt was made to determine whether 36 long-term kidney homograft recipients and their donors were compatible for 7 major leukocyte groups. It was found that 21 of these recipients were surviving 2 to 3 years in spite of incompatibility for 1 or 2 major leukocyte antigens. Survival of mismatched grafts does not itself indicate that the antigens being measured are not transplantation antigens, for it was shown that the 15 recipients with no groups of mismatch were clinically superior to those with group incompatibilities. Moreover, histopathologic scores given to biopsy specimens taken 2 to 3 years after transplantation were significantly correlated with the number of group mismatches. Because the leukocyte groups were determined by cytotoxicity reactions of peripheral blood lymphocytes, the results may have been influenced considerably by chimerism in chronically dialyzed uremic patients or change in lymphocyte antigenicity or susceptibility to lysis upon prolonged immunosuppressive treatment. Although the possibility of these complications could not be ruled out in all instances, it was shown that 52 dialyzed uremic patients and 49 patients who had been treated with immunosuppression for over 1 year did not possess more or less antigens than a random population of normal individuals. It is concluded that: (1) the major leukocyte antigens are histocompatibility antigens, and (2) since survival can be attained at times despite mismatches for these groups, the antigens are of intermediate strength and kidney homograft rejection may occur if excessive numbers of antigens are incompatible or if particular combinations of antigens are mismatched. © 1966 by The Williams and Wilkins Co