Starzl T E, Boehmig H J, Amemiya H, Wilson C B, Dixon F J, Giles G R, Simpson K M, Halgrimson C G
N Engl J Med. 1970 Aug 20;283(8):383-90. doi: 10.1056/NEJM197008202830801.
One of two patients in whom early homograft rejection developed after renal transplantation had many antidonor antibodies before operation. By the measurement of gradients across intracorporeal and extracorporeal homografts in this patient, the new kidneys were shown to sequester host immunoglobulins, platelets, white cells and clotting factors. Moreover, the renal venous blood then contained fibrinolytic activity. This presensitized recipient, as well as a second patient who did not have detectable preformed humoral antibodies, gave evidence from clinical observation and from the various clotting tests of disseminated intravascular coagulation with fibrinolysis and a severe bleeding, diathesis. Immunofluorescent and histologic studies revealed a laying down of fibrin in the homograft vessels that continued in some cases to cortical necrosis of the transplanted kidneys or, alternatively, receded at the time fibrinolysis occurred. The variety of rejection seen in these patients has been characterized as an immunologically induced coagulopathy.
在两例肾移植后发生早期同种移植排斥反应的患者中，有一例在手术前存在许多抗供体抗体。通过测量该患者体内和体外同种移植的梯度，发现新肾会隔离宿主免疫球蛋白、血小板、白细胞和凝血因子。此外，肾静脉血中当时含有纤溶活性。这位预先致敏的受者以及另一位未检测到预先形成的体液抗体的患者，从临床观察以及各种凝血试验中都显示出存在伴有纤溶的弥散性血管内凝血和严重的出血素质。免疫荧光和组织学研究显示，同种移植血管中有纤维蛋白沉积，在某些情况下这种沉积会持续到移植肾皮质坏死，或者在纤溶发生时消退。这些患者中所见的排斥反应类型被描述为免疫诱导的凝血病。
