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. 1974 Oct;180(4):606–614. doi: 10.1097/00000658-197410000-00026

A Decade Followup in Early Cases of Renal Homotransplantation

T E Starzl, K A Porter, C G Halgrimson, B S Husberg, I Penn, C W Putnam
PMCID: PMC1344153  PMID: 4606113

Abstract

Sixty-four consecutive patients underwent renal homotransplantation 10 1/6 to 11½ years ago, 46 from related and 18 from nonrelated living donors. Thirty-six of these recipients were alive when this series was presented to the American Surgical Assocation in 1965. Now, nine years later, 26 (72%) of the 36 still survive, in 22 instances with function of their original grafts. The 10 who died in the interim tended to have subnormal renal function or graft failure. However, the actual causes of death included 2 or more examples each of myocardial infarction, hepatitis, or other systemic infections. The prognosis for achieving a one decade survival was not obviously related to HL-A tissue match. The best results were with related kidneys, within which subgroup 24 (52%) of the original recipients are still alive. However, there was no particular category of consanguineous donor that had a marked superiority. Only 2 of 18 nonrelated recipients are still alive. All 36 patients who were alive in 1965 had a biopsy of their renal homograft. Kidneys that were destined to function for a decade tended to have relatively minor histopathologic abnormalities. If serious glomerular lesions were found, the outlook for long graft survival was grave. Vascular lesions had a somewhat less serious import. Mononuclear cell infiltration, tubular atrophy, and interstitial fibrosis proved prognostically to be the least significant. Long-term followup of these early cases has shown the durability of chronic renal homografts, particularly if these are from related donors, and has demonstrated the very high degree of rehabilitation that could be achieved even in the early days of renal homotransplantation.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amos D. B., Bach F. H. Phenotypic expressions of the major histocompatibility locus in man (HL-A): leukocyte antigens and mixed leukocyte culture reactivity. J Exp Med. 1968 Oct 1;128(4):623–637. doi: 10.1084/jem.128.4.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Busch G. J., Galvanek E. G., Reynolds E. S., Jr Human renal allografts. Analysis of lesions in long-term survivors. Hum Pathol. 1971 Jun;2(2):253–298. doi: 10.1016/s0046-8177(71)80037-0. [DOI] [PubMed] [Google Scholar]
  3. Glassock R. J., Feldman D., Reynolds E. S., Dammin G. J., Merrill J. P. Human renal isografts: a clinical and pathologic analysis. Medicine (Baltimore) 1968 Sep;47(5):411–454. doi: 10.1097/00005792-196809000-00002. [DOI] [PubMed] [Google Scholar]
  4. HAMBURGER J., CROSNIER J., DORMONT J. OBSERVATIONS IN PATIENTS WITH A WELL-TOLERATED HOMOTRANSPLANTED KIDNEY: POSSIBILITY OF A NEW SECONDARY DISEASE. Ann N Y Acad Sci. 1964 Nov 30;120:558–577. doi: 10.1111/j.1749-6632.1964.tb34753.x. [DOI] [PubMed] [Google Scholar]
  5. HAMBURGER J., VAYSSE J., CROSNIER J., AUVERT J., LALANNE C. M., HOPPER J., Jr Renal homotransplantation in man after radiation of the recipient. Experience with six patients since 1959. Am J Med. 1962 Jun;32:854–871. doi: 10.1016/0002-9343(62)90032-3. [DOI] [PubMed] [Google Scholar]
  6. HUME D. M., MAGEE J. H., KAUFFMAN H. M., Jr, RITTENBURY M. S., PROUT G. R., Jr RENAL HOMOTRANSPLANTATION IN MAN IN MODIFIED RECIPIENTS. Ann Surg. 1963 Oct;158:608–644. doi: 10.1097/00000658-196310000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Halgrimson C. G., Wilson C. B., Dixon F. J., Anderson J. T., Ogden D. A., Starzl T. E. Goodpasture's syndrome. Treatment with nephrectomy and renal transplantation. Arch Surg. 1971 Aug;103(2):283–289. doi: 10.1001/archsurg.1971.01350080199031. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hamburger J., Berger J., Hinglais N., Descamps B. New insights into the pathogenesis of glomerulonephritis afforded by the study of renal allografts. Clin Nephrol. 1973 Jan-Feb;1(1):3–7. [PubMed] [Google Scholar]
  9. KUSS R., LEGRAIN M., MATHE G., NEDEY R., CAMEY M. Homologous human kidney transplantation. Experience with six patients. Postgrad Med J. 1962 Sep;38:528–531. doi: 10.1136/pgmj.38.443.528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. MURRAY J. E., MERRILL J. P., DAMMIN G. J., DEALY J. B., Jr, ALEXANDRE G. W., HARRISON J. H. Kidney transplantation in modified recipients. Ann Surg. 1962 Sep;156:337–355. doi: 10.1097/00000658-196209000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. MURRAY J. E., MERRILL J. P., DAMMIN G. J., DEALY J. B., Jr, WALTER C. W., BROOKE M. S., WILSON R. E. Study on transplantation immunity after total body irradiation: clinical and experimental investigation. Surgery. 1960 Jul;48:272–284. [PubMed] [Google Scholar]
  12. MURRAY J. E., MERRILL J. P., HARRISON J. H., WILSON R. E., DAMMIN G. J. Prolonged survival of human-kidney homografts by immunosuppressive drug therapy. N Engl J Med. 1963 Jun 13;268:1315–1323. doi: 10.1056/NEJM196306132682401. [DOI] [PubMed] [Google Scholar]
  13. McPhaul J. J., Jr, Dixon F. J., Brettschneider L., Starzl T. E. Immunofluorescent examination of biopsies from long-term renal allografts. N Engl J Med. 1970 Feb 19;282(8):412–417. doi: 10.1056/NEJM197002192820802. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. PORTER K. A., THOMSON W. B., OWEN K., KENYON J. R., MOWBRAY J. F., PEART W. S. OBLITERATIVE VASCULAR CHANGES IN FOUR HUMAN KIDNEY HOMOTRANSPLANTS. Br Med J. 1963 Sep 14;2(5358):639–645. doi: 10.1136/bmj.2.5358.639. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Penn I., Starzl T. E. Immunosuppression and cancer. Transplant Proc. 1973 Mar;5(1):943–947. [PMC free article] [PubMed] [Google Scholar]
  16. Porter K. A., Andres G. A., Calder M. W., Dossetor J. B., Hsu K. C., Rendall J. M., Seegal B. C., Starzl T. E. Human renal transplants. II. Immunofluorescent and immunoferritin studies. Lab Invest. 1968 Feb;18(2):159–171. [PubMed] [Google Scholar]
  17. Porter K. A. Clinical renal transplantation. Int Rev Exp Pathol. 1972;11:73–176. [PubMed] [Google Scholar]
  18. SHACKMAN R., DEMPSTER W. J., WRONG O. M. KIDNEY HOMOTRANSPLANTATION IN THE HUMAN. Br J Urol. 1963 Sep;35:222–255. doi: 10.1111/j.1464-410x.1963.tb06900.x. [DOI] [PubMed] [Google Scholar]
  19. STARZL T. E., MARCHIORO T. L., WADDELL W. R. THE REVERSAL OF REJECTION IN HUMAN RENAL HOMOGRAFTS WITH SUBSEQUENT DEVELOPMENT OF HOMOGRAFT TOLERANCE. Surg Gynecol Obstet. 1963 Oct;117:385–395. [PMC free article] [PubMed] [Google Scholar]
  20. Starzl T. E., Marchioro T. L., Terasaki P. I., Porter K. A., Faris T. D., Herrmann T. J., Vredevoe D. L., Hutt M. P., Ogden D. A., Waddell W. R. Chronic survival after human renal homotransplantation. Lymphocyte-antigen matching, pathology and influence of thymectomy. Ann Surg. 1965 Oct;162(4):749–787. doi: 10.1097/00000658-196510000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Starzl T. E., Porter K. A., Andres G., Halgrimson C. G., Hurwitz R., Giles G., Terasaki P. I., Penn I., Schroter G. T., Lilly J. Long-term survival after renal transplantation in humans: (with special reference to histocompatibility matching, thymectomy, homograft glomerulonephritis, heterologous ALG , AND RECIPIENT MALIGNANCY). Ann Surg. 1970 Sep;172(3):437–472. doi: 10.1097/00000658-197009000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. TOWNSEND J. D. MORAL PROBLEMS IN THE USE OF BORROWED ORGANS, ARTIFICIAL AND TRANSPLANTED. Ann Intern Med. 1964 Feb;60:309–313. [PubMed] [Google Scholar]
  23. WOODRUFF M. F., NOLAN B., WILSON T. I., ROBSON J. S., LAMBIE A. T., CLARK J. G. HOMOTRANSPLANTATION OF KIDNEY IN PATIENTS TREATED BY PREOPERATIVE LOCAL IRRADIATION AND POSTOPERATIVE ADMINISTRATION OF AN ANTIMETABOLITE (IMURAN). REPORT OF SIX CASES. Lancet. 1963 Sep 28;2(7309):675–682. doi: 10.1016/s0140-6736(63)90465-3. [DOI] [PubMed] [Google Scholar]
  24. Wilson C. B., Dixon F. J. Anti-glomerular basement membrane antibody-induced glomerulonephritis. Kidney Int. 1973 Feb;3(2):74–89. doi: 10.1038/ki.1973.14. [DOI] [PubMed] [Google Scholar]
  25. ZUKOSKI C. F., ENDE N. MEMBRANOUS GLOMERULAR NEPHRITIS COMPLICATING PROLONGED SURVIVAL OF A HOMOGRAPHED KIDNEY. Transplantation. 1965 Jan;3:118–122. [PubMed] [Google Scholar]

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