Anderson C B, Sicard G A, Etheredge E E
Surgery. 1982 Aug;92(2):315-21.
Improvement of renal allograft survival by induction of immunologic unresponsiveness was attempted in 24 patients by the pretransplant administration of donor-specific whole blood or buffy coat under continuous azathioprine immunosuppression. All patients and their donors had one or two disparate HLA haplotypes. Crossmatch (CM) testing (22 degrees C) for T cells (Amos and antiglobulin enhanced) and B cells identified sensitization in two patients (8%). One developed a low titer (1:2) positive B-cell CM, which did not preclude successful transplantation. The second, with a preexisting high titer (1:16) positive B-cell CM, developed a low titer (1:1) T-cell antiglobulin CM and had hyperacute graft rejection. Twenty-one recipients received kidneys from their blood donors. Except for one patient who had hyperacute rejection (across positive T-cell CM), none have rejected their kidneys. Three patients died at 2, 13, and 23 months, respectively, with good renal function. Seventeen patients are alive at 3 months to 10 years with a mean serum creatinine concentration of 1.3 +/- 0.4 mg/dl. Donor-specific transfusion with immunosuppressive coverage improves renal allograft survival without significant sensitization.
在24例患者中尝试通过在硫唑嘌呤持续免疫抑制下移植前给予供者特异性全血或血沉棕黄层来诱导免疫无反应性，以提高肾移植存活率。所有患者及其供者均有一个或两个不相合的HLA单倍型。对T细胞（阿莫斯法和抗球蛋白增强法）和B细胞进行交叉配型（22℃）检测发现，两名患者（8%）存在致敏。其中一名患者出现低滴度（1:2）阳性B细胞交叉配型，这并未妨碍成功移植。另一名患者先前存在高滴度（1:16）阳性B细胞交叉配型，出现低滴度（1:1）T细胞抗球蛋白交叉配型，并发生了超急性移植排斥反应。21名受者接受了来自其献血者的肾脏。除一名发生超急性排斥反应（T细胞交叉配型阳性）的患者外，其余患者均未排斥其肾脏。三名患者分别在2个月、13个月和23个月死亡，肾功能良好。17名患者存活3个月至10年，平均血清肌酐浓度为1.3±0.4mg/dl。给予免疫抑制覆盖的供者特异性输血可提高肾移植存活率，且无明显致敏现象。
