David M. Hume

Hyperacute Renal-Homograft Rejection in Man

Abstract Biopsies of renal transplants taken within one hour after completion of vascular anastomoses revealed, in seven of 132 cases, the accumulation of large numbers of polymorphonuclear leukocytes within glomerular and peritubular capillaries, with eventual transplant failure in all cases. Serologic studies in all recipients demonstrated pre-existing antibodies reacting with human histocompatibility antigens. Heat eluates from three of four rejected kidneys also contained activity against human histocompatibility antigens. These findings suggest that serum antibody reacted with and became fixed to the histocompatibility antigens of the graft, thereby initiating an acute vascular reaction with early polymorphonuclear-leukocyte margination and progression to widespread capillary thrombosis.

Relevance of HL-A Antigens to Acute Humoral Rejection of Multiple Renal Allotransplants

Abstract Acute humoral (hyperacute) rejection occurred in 3.3 per cent of 153 first renal allotransplants and in 35 per cent of 31 second, third and fourth transplants. To test whether or not immunization by previous transplants to HL-A antigens distributed at two subloci could account for this striking increase in the frequency of immunization, the Immunization Index was calculated for donor recipient combinations of various relatedness, races and numbers of transplants. The figure of 11 cases of acute humoral rejections in 31 multiple transplants correlated well with 12.2 cases predicted by the model, and there was similar close agreement for several subgroups. Immunization to the HL-A system of histocompatibility antigens is probably sufficient to account for the percentage of acute humoral rejections observed in recipients of multiple renal allotransplants without the involvement of a third HL-A sublocus or other histocompatibility loci.

Separation of Massive Avascular Osteocartilaginous Fragment of Femoral Condyle Following Renal Transplantation

Avascular msccrosis of the femoral condylc follosving renal transplamstation has beets described in our osvn series of cases 6 and in those of others This report describes the shedding of a massive fragment into the knee ins tss-o of our three paticmsts kmsown to have avascular necrosis of the distal emsd of the femur. No previous report of this complication follosvimsg renal transplantation is kmsosvn.