Abstract
Thoracic duct drainage has been clinically used for immunomodulation in autoimmune diseases and pretreatment of kidney transplantation. However although clinical usefulness has been advocated, actual application has been limited probably mainly due to complexity in its maneuver. In an attempt to solve the problems, a novel CTDD system which utilizes filtration of lymphatic fluid to collect lymphocytes has been devised and evaluated both experimentally and clinically. Animal experiments in mongrel dogs using membrane filters with pore size 0.8 micron revealed good results showing a lymph flow rate of 40-90ml/h and a number of lymphocytes of 2.0-4.3×106/ml thoroughly trapped in the filter. In clinical applications, a small membrane plasma separator was used. Up to 109/day of lymphocytes were trapped in up to 2000ml/day of lymph collected in three malignant rheumatic arthritis patients. Clinical symptoms have been miraculously ameliorated with a marked reduction in a Leu 3a/Leu 2a ratio and improvement in ESR. In conclusion, as proved to be simple in manipulation and reliable in function, the system is expected to open a new era in extracorporeal immunomodulation therapy.
