Fractionated total lymphoid irradiation as preparative immunosuppression in high risk renal transplantation: clinical and immunological studies

Journal Article · Fri Oct 01 04:00:00 EDT 1982 · Ann. Surg.; (United States)

DOI:https://doi.org/10.1097/00000658-198210000-00007· OSTI ID:6579793

Najarian, J S; Ferguson, R M; Sutherland, D E; Slavin, S; Kim, T; Kersey, J; Simmons, R S

Twenty-two patients at high risk to reject renal allografts have been treated with fractionated total lymphoid irradiation (FTLI) prior to transplantation of primary (2), secondary (16) or teritary (4) renal allografts. All patients undergoing retransplantation had rapidly rejected previous grafts. At 24 months following transplantation, 72% of grafts were functioning in the TLI group compared with a 38% graft function in an historical control group of recipients receiving secondary or tertiary grafts and treated with conventional immunosuppression. Important variables in determining success of transplantation following fractionated TLI include the dose of TLI, the interval from radiation to transplantation, and maintenance, post-transplant immunosuppressive therapy. Optimal results were achieved with 2500 rads delivered in 100 rad fractions followed by transplantation within two weeks, and a tapering prednisone schedule and maintenance azathioprine post-transplantation. Seventeen patients had significant complications of the radiation treatment and there was one death, prior to transplantation, associated with pneumonitis. In vitro assessment of immune function demonstrated marked peripheral T cell depletion and loss of in vitro responsiveness to mitogen and allogeneic stimulation following FTLI. The administration of donor bone marrow at the time of transplantation did not produce chimerism. The results suggest that when properly utilized FTLI can produce effective adjunctive immunosuppression for clinical transplantation.

• Research Organization: Department of Surgery, Therapeutic Radiology and Pediatrics, University of Minnesota, Minneapolis
• OSTI ID: 6579793
• Journal Information: Ann. Surg.; (United States), Journal Name: Ann. Surg.; (United States) Vol. 196:4; ISSN ANSUA
• Country of Publication: United States
• Language: English

Related Subjects

550603 -- Medicine-- External Radiation in Therapy-- (1980-)
560151* -- Radiation Effects on Animals-- Man
62 RADIOLOGY AND NUCLEAR MEDICINE
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
BODY
DOSES
DRUGS
FRACTIONATED IRRADIATION
GRAFT-HOST REACTION
IMMUNOSUPPRESSION
IMMUNOSUPPRESSIVE DRUGS
IRRADIATION
KIDNEYS
LYMPH NODES
LYMPHATIC SYSTEM
ORGANS
PATIENTS
RADIATION DOSES
TRANSPLANTS