Immunological and clinical observations in diabetic kidney graft recipients pretreated with total-lymphoid irradiation

Journal Article · Sun Mar 01 04:00:00 EST 1987 · Transplantation; (United States)

DOI:https://doi.org/10.1097/00007890-198703000-00011· OSTI ID:6858840

Waer, M; Vanrenterghem, Y; Roels, L; Ang, K K; Bouillon, R; Lerut, T; Gruwez, J; van der Schueren, E; Vandeputte, M; Michielsen, P

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), Journal Name: Transplantation; (United States) Vol. 3; ISSN TRPLA
• Country of Publication: United States
• Language: English

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550901 -- Pathology-- Tracer Techniques
560120* -- Radiation Effects on Biochemicals
Cells
& Tissue Culture
59 BASIC BIOLOGICAL SCIENCES
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
ANIMAL CELLS
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
CONNECTIVE TISSUE CELLS
DIABETES MELLITUS
DISEASES
ENDOCRINE DISEASES
FEASIBILITY STUDIES
FRACTIONATED IRRADIATION
GRAFT-HOST REACTION
IMMUNOSUPPRESSION
IRRADIATION
KIDNEYS
LEUKOCYTES
LYMPHOCYTES
MATERIALS
METABOLIC DISEASES
ORGANS
PATIENTS
SOMATIC CELLS
TRANSPLANTS