1987 Volume 78 Issue 4 Pages 579-585
Thoracic duct drainage (TDD) given to prospective kidney transplant patients has resulted in a significant improvement in the graft survival rate. Thirty-six patients receiving TDD pretreatment got a kidney transplanted from HLA one-haploidentical living related donors. The graft survival was 100% after 1 and 2 years, confirming the superiority of TDD conditioning over the previous results with non pretreatment HLA one-haploidentical kidney transplanted patients. To investigate the mechanism of this beneficial effect, we have analysed immune response in the patients receiving TDD pretreatment.
Peripheral blood mononuclear (MN) cells were obtained before and every 10 days during TDD pretreatment and were tested for ability to respond against donor cells in MLR and to suppress MLR of third party. Stimulation index (RDx/RRx) was 7.3±6.7 before TDD, 3.0±2.9 (p<0.025) 10 days after TDD, 2.4±1.7 (p<0.005) 20 days and 2.9±2.6 (p<0.005) 30 days. The value of MLR-suppression was -33±23% in the patients prior to TDD pretreatment and -37±29% in control patients maintained by H. D. In proportion to the duration of TDD, especially 20 days after TDD, MLR suppression gradually increased (r=0.77, p<0.001).
In conclusion, our data suggest that TDD pretreatment yields a hyporesponsiveness against the donor allo-antigens and the hyporesponsiveness might be partially induced by suppressor cells.
