Abstract
Between November 24, 1962, and May 15, 1963, 12 renal homografts were done at the University of Colorado Medical Center. In half of the cases, a kidney was provided by a donor of the same major blood type as the recipient. In the other half, the major blood groups of the donor and recipient patients were different. The present study is concerned with an analysis of the results in these comparative series, in order to determine what influence the presence or absence of major blood group compatibility had upon the early success rate.
Methods
The blood types and the genetic relationships of the donors and recipients are shown in Table I. Each group contained a set of male fraternal twins, as well as one cadaver donation. The periods of renal ischemia were comparable in the 2 groups. Genetic relationships were slightly more favorable in the series with matched blood types. The basic antirejection therapy in every case consisted of azathioprine (imuran), although Patient 1 also received total body irradiation. Eleven of the 12 patients received splenectomy or splenectomy plus thymectomy. The method of homograft preservation differed in the 2 groups. With compatible blood types, total body donor hypothermia and systemic heparinization were employed. With blood type differences, the donor patients were neither cooled nor heparinized, but the kidney was perfused after removal with cooled lactated Ringer's solution (15° C.), to which procaine chloride (1 gm./L.) and heparin (50 mg./L.) were added. Mannitol, 250 to 800 mg./kg., was given during and after renal revascularization.
Table I. Clinical Data.
| PATIENT NO. | DONOR-RECIPIENT BLOOD TYPES | DONOR-RECIPIENT RELATION | DATE TRANSPLANTATION | RENAL FUNCTION 6-1-63 | ADJUVANT SURGERY |
|---|---|---|---|---|---|
| COMPATIBLE BLOOD TYPES | |||||
| 1 | B+–B+ | Mother-son | 11-24-62 | Good | Thymectomy, splenectomy |
| 2 | A+–A+ | Fraternal twins | 2- 9-63 | Good | Thymectomy, splenectomy |
| 3 | A+–A+ | Unrelated volunteer | 3-26-63 | Sepsis, rejection * | Thymectomy, splenectomy |
| 4 | O+–O+ | Brother-brother | 4-17-63 | Good | Thymectomy, splenectomy |
| 5 | A+–A+ | Cadaver | 4-19-63 | Ruptured kidney homograft, 12 days † | Thymectomy, splenectomy |
| 6 | O+–O+ | Brother-brother | 5- 8-63 | Good | Splenectomy |
| INCOMPATIBLE BLOOD TYPES | |||||
| 7 | B+–A+ | Sister-brother | 1-30-63 | Good | Thymectomy, splenectomy |
| 8 | A+–AB+ | Wife-husband | 2-25-63 | Good | Splenectomy, thymectomy |
| 9 | A+–O+ | Cadaver | 3-19-63 | Sepsis, rejection ** | None |
| 10 | O+–A+ | Wife-husband | 5- 3-63 | Good | Splenectomy |
| 11 | O+–A+ | Fraternal twins | 5-10-63 | Good | Thymectomy, splenectomy |
| 12 | O+–O− | Unrelated volunteer | 5-15-63 | Good | Splenectomy |
NOTE: All patients or cadavers were male unless otherwise indicated.
Died 10 days
Awaiting second homograft
Died 24 days
Results
Urine flow began in a few minutes or hours in all except Patient 5, in whom urine was never produced in significant quantities. In Patients 3 and 9, urine output of 2,000 to 3,000 cc. per day occurred, but the BUN did not return to normal. In the other 9 patients, massive diuresis of 6,000 to 16,000 cc. per day resulted in prompt resolution of azotemia. The immediate behavior of the homografts was not significantly influenced by the presence or absence of blood group compatibility.
Except for Patient 2, all patients underwent a rejection crisis which was first evident 4 to 27 days after transplantation. This was reversed by the addition of actinomycin C and massive steroid therapy to the pre-existing therapy. Neither the vigor nor the reversibility of rejection was related to blood type similarities or differences.
Summary
Renal homografts from donors with blood types different from those of the recipient patients have provided satisfactory renal function in 6 patients for as long as 4 months. The early success rate under these circumstances has been comparable to that attained in a companion series in which donor-recipient major blood groups were identical.