Immunological and clinical observations in diabetic kidney graft recipients pretreated with total-lymphoid irradiation
In a feasibility study, twenty patients with end-stage diabetic nephropathy were treated with fractionated total-lymphoid irradiation (TLI, mean dose 25 Gy), before transplantation of a first cadaveric kidney. During radiotherapy, only one patient had a serious side effect (bone marrow depression). After transplantation four patients died (one of a myocardial infarction, one of ketoacidosis, and two of infections occurring during treatment of rejection crises). One graft was lost because of chronic rejection. The other 15 patients have a functioning graft (mean follow-up 24 months) and receive low-dose prednisone alone (less than 10 mg/day, n = 11) or in conjunction with cyclosporine (n = 4) as maintenance immunosuppressive therapy. A favorable clinical outcome after TLI (no, or only one, steroid-sensitive rejection crisis) was significantly correlated with a high pre-TLI helper/suppressor lymphocyte ratio, a short interval between TLI and the time of transplantation, and the occurrence of functional suppressor cells early after TLI. The most striking immunological changes provoked by TLI consisted of a long-term depression of the mixed lymphocyte reaction and of the phytohemagglutinin, and Concanavalin A or pokeweed-mitogen-induced blastogenesis. A rapid and complete recovery of the natural killer cell activity was observed after TLI. A permanent inversion of the OKT4+ (T helper/inducer) over OKT8+ (T suppressor/cytotoxic) lymphocyte ratio was provoked by a decrease of the OTK4+ subpopulation, together with a supranormal recovery of the OKT8+ lymphocytes. A majority of the latter lymphocytes did also express the Leu 7 and the Leu 15 phenotype.
- Research Organization:
- Univ. of Leuven, Belgium
- OSTI ID:
- 6858840
- Journal Information:
- Transplantation; (United States), Vol. 3
- Country of Publication:
- United States
- Language:
- English
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59 BASIC BIOLOGICAL SCIENCES
KIDNEYS
TRANSPLANTS
LYMPHOCYTES
IRRADIATION
DIABETES MELLITUS
FEASIBILITY STUDIES
FRACTIONATED IRRADIATION
GRAFT-HOST REACTION
IMMUNOSUPPRESSION
PATIENTS
ANIMAL CELLS
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
CONNECTIVE TISSUE CELLS
DISEASES
ENDOCRINE DISEASES
LEUKOCYTES
MATERIALS
METABOLIC DISEASES
ORGANS
SOMATIC CELLS
560120* - Radiation Effects on Biochemicals
Cells
& Tissue Culture
550901 - Pathology- Tracer Techniques