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PMID: 384943 Published · ppublish English Journal Article Research Support, U.S. Gov't, Non-P.H.S. Research Support, U.S. Gov't, P.H.S.

Thoracic duct fistula and renal transplantation.

Annals of surgery ·Vol. 190 ·No. 4 ·1979-10-00 ·Pages 474-86

Starzl TE, Weil R, Koep LJ, McCalmon RT, Terasaki PI, Iwaki Y, Schröter GP, Franks JJ, Subryan V, Halgrimson CG

Abstract

Thoracic duct drainage (TDD) was established for 21-115 days in 40 kidney recipients with an average removal per patient day of 4.7 1 lymph and 1.88 billion cells. Cellular and humoral immunity were depressed. TDD and immunosuppressive drugs were started at transplantation in 35 recipients of cross-match negative grafts. Although the results were better than in precedent non-TDD controls, eight patients rejected their grafts before a full TDD effect, and three of the eight developed predominantly anti-B lymphocyte cytotoxic antibodies which were probably responsible for positive cross-matches with their next donors. With continuing TDD, all eight patients had good initial function after early retransplantation. In five more "nontransplantable" patients with performed cytotoxic antibodies, TDD was started 30-56 days before transplantation. In these five pretreated patients, antibodies persisted with positive antidonor cross-matches. Hyperacute rejection occurred repeatedly in two patients with high anti-T (and anti-B) titers, but was surmounted in three patients with lower titers. From the clinical and immunologic data, we have concluded that TDD should be used for pretreatment of all cases with or without prior antibodies, and have suggested an adjustable management plan that takes into account new developments in antibody monitoring.

MeSH Terms
Adolescent Adult Antibodies/analysis Antilymphocyte Serum Cadaver Child Cytotoxicity Tests, Immunologic Drainage Graft Rejection Humans Immunoglobulin A/analysis Immunoglobulin G/analysis Immunoglobulin M/analysis Immunosuppression Therapy Kidney Transplantation Lymph Middle Aged Postoperative Care Skin Tests Thoracic Duct/surgery Transplantation Immunology Transplantation, Homologous
Chemicals
Antibodies Antilymphocyte Serum Immunoglobulin A Immunoglobulin G Immunoglobulin M
Authors & Affiliations
10 authors, click to expand affiliations / ORCID
Starzl T E
Weil R
Koep L J
McCalmon R T
Terasaki P I
Iwaki Y
Schröter G P
Franks J J
Subryan V
Halgrimson C G
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45 references, click to expand
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Article Info
Journal
Annals of surgery
Abbr.
Ann Surg
ISSN
0003-4932
DOI
10.1097/00000658-197910000-00007
Published
1979-10-00
Pages
474-86
Language
English
Region
United States
NLM ID
0372354
PMCID
PMC1344512
Subset
IM
External Links
PubMed source DOI: 10.1097/00000658-197910000-00007 PMC Full Text View journal details
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