EXPERIMENTAL STUDIES ON RENAL TRANSPLANTATION WITH SPECIAL REFERENCE TO OBSERVATIONS ON THE BLOOD SUPPLY BY AORTOGRAPHY

Abstract

For the purpose of establishing the value of renal angiography in detecting the early sign of renal homograft rejection, and diferenciating the other causes of postoperative renal insufficiency apt to be confused with the signs of rejection, we performed renal auto- and homotransplantation in adult mongrel dogs. Transfemoral renal angiography was performed at several intervals after an operation, and postmortem angiographic, microangiographic and histological examinations were also performed. In addition, we carried out the evaluation of the immunosuppressive effect of a few drugs. The results of these experiments were as follows;
1) When the ureter was anastomosed to the skin in autotransplanted groups, retrograde infection was frequently seen. So, the findings of pyelonephritis were angiographically seen. On the other hand, when the ureter was implanted into the bladder, the findings of infection decreased markedly and intrarenal arteries showed normal appearances.
2) Accordingly we implanted the ureter into the bladder, and performed various antibiotic therapies in all homotransplanted cases in order to avoid that inflammatory changes should affect renal vascular changes of the homotransplantation itself, and followngi results were obtained.
a) In the homotransplanted group without immunosuppression, the aorta of the host gradually decreased in size angiographically, and this finding was not seen in the Imuran-treated group. Consequently, the authors supposed that there were some immunological factors which caused this phenomenon.
b) The angiographic changes of the intrarenal branches in the homotransplanted kidney were spread, narrowing, straightenning, sparse distribution, marginal beading, etc. These findings resembled those of pyelonephritis.
c) The most specific finding which was seen in the homotransplanted kidney was diffuse linear deficit of cortical opacification in the nephrographic phase. In some cases this change was seen earlier than other angiographic changes or histological changes or elevation of BUN. Consequently, we supposed that this finding was one of the earliest signs of the homograft rejection.
d) The immunosuppressive effect of Glycirrhizin was not so marked, and as to Cobaltiprotoporphyrin, we could not find any immunosuppressive effect. But, our series were too few to elicit some conclusion about immunosuppressive effects of these drugs, and we expected further experiments.
3) According to the findings on the postmortem renal arteriogram, the microangiogram and the histological section, it is concluded that the arteriographic findings in homotransplanted kidney in vivo in dicate not only the change of the artery itself, but also the presence of lesion in periarterial tissue, which affects the blood supply, and reveal the localization and the extent of the disturbance of the renal function.