LYMPHAPHERESIS- A NEW IMMUNOSUPPRESSIVE METHOD IN RENAL TRANSPLANTATION

Abstract

One of the major problems to be solved in renal transplantation is how to achieve satisfactory immunosuppressive effects and reduce complications arising from immunosuppression.
As is generally known, various lymphocytes hold the key to the occurrence of acute rejection.
As a new trial for the immunosuppressive method in renal transplantation, we carried out removal of lymphocytes, that is, lymphapheresis by the use of Blood Cell Separator (IBM 2997).
Blood flow taken out of a shunt for dialysis is treated with Blood Cell Separator to remove only lymphocytes, while plasma and other cells are returned continuously into the body.
On the average 3×10⁹ lymphocytes were removed at the time of each lymphapheresis. Some platelets and granulocytes adjacent to the lymphocytic layer were also removed. However, the numbers of peripheral platelets and leukocytes showed no significant decrease.
On the other hand, the number of peripheral lymphocytes decreased significantly after single lymphapheresis but leveled off thereafter despite repeated lymphapheresis.
Single lymphapheresis took about two hours and the amount of blood treated was 6L for adults and 3L for children.
We provided a bypass on the venous side of the hemodialysis circuit so that lymphapheresis can be performed during hemodialysis.
Subsequently, lymphapheresis can be performed without any further intervention on the patients in preoperative hemodialysis or when hemodialysis is needed for postoperative ATN (acute tubular necrosis) or rejection.
Furthermore, lymphapheresis has contributed to perform renal transplantation easily and safely and can be performed whenever it is needed before and after transplantation.
Biopsy of lymph nodes after lymphapheresis showed a distinct atrophy.
Preoperative lymphapheresis was performed in 11 cases of renal transplantation from March, 1981, to October, 1982, at our institution.
Among these 11 cases, only one case showed rejection leading to the graft loss, although they were varied in the histocompatibility, the number of repeated lymphapheresis before the operation (2-30 times) and the duration of postoperative observation (1-20 months). This was a case in which administration of immunosuppressive agents could not be continued because of respiratory complication.
Mild rejection occurred in most of the cases but it recovered easily with an increased dosis of steroid.
The cases treated with preoperative lymphapheresis tended to require less amount of steroid compared to the cases receiving no lymphapheresis.
The result of preoperative lymphapheresis in renal transplantation has so far been satisfactory.