Allan E. Kark

IMMUNOLOGIC OBSERVATIONS ON HOMOGRAFTS. II. THE CANINE KIDNEY.

Renal transplants in adult dogs (23 first-set homografts and 11 autografts) were removed at 12 hours to 7 days after transplantation and studied histologically and immunocytochemically. The rejection of renal homografts is associated with an infiltrate of lymphocytes, hemocytoblasts and immature and mature plasma cells containing gamma globulin. Beginning at 3 to 4 days the interlobular arteries down to the afferent arterioles show a focal, progressive degeneration with media vacuolization and necrosis, and at 5 to 6 days endothelial proliferation and thrombosis set in. Coincidentally, in the altered vessels small droplets contain only γ-globulin which can be eluted with an acid buffer and binds in vitro complement, suggesting that the γ-globulin is part of an antigen-antibody complex. Hypothetically, antibody is formed in response to antigen from the graft in the rejection of kidney homografts. Then antigen-antibody complexes, localized or formed in the walls of small blood vessels, cause necrosis and endothelial proliferation that result in thrombosis and tissue necrosis which terminates the rejection.

Rejection of the homotransplanted dog liver in the absence of hepatic insufficiency.

Summary A method is presented for transplantation of a donor liver into the pelvis of recipient dogs without disturbing the recipient liver. This surgical preparation has been designed for the study of the immunologic rejection of the liver in the absence of hepatic insufficiency and of jaundice. The recipient liver shows only nonspecific changes. No evidence of an immunologic attack of the graft on the host liver is recognizable. The donor liver exhibits transient anoxic changes which do not appear to interfere with hepatic function as judged by its sequential biliary secretion. Bile secretion ceases within 8 days. Piecemeal necrosis, particularly accentuated on the lobular periphery near the portal tracts, leads to a relentless elimination of all liver cells and their replacement by immunologically active cells within 20 days. The initial stage of this rejection resembles the peripheral piecemeal necrosis of chronic active hepatitis and progressing cirrhosis in man.

Use of transhepatic intubation in biliary stricture repair

Abstract Two cases are presented of repair of posttraumatic stricture of the common bile duct using transhepatic intubation. The same technic has been used for palliation of malignant obstruction of the common hepatic duct. The technic seems to be an advance over methods of intubation led externally from the jejunum.