F. Mercuriali

The Cadaver Kidney Transplantation Programme Of Milano Immunological Report

A retrospective investigation was carried out to evaluate the infuence of HLA (A, B) matching, blood transfusions, and preexistence of lymphocytotoxic antibodies on the outcome of the cadaver kidney graft: only non-NIH standard antibodies were considered, since patients with NIH standard antibodies do not undergo transplantation in the programme of Milano. It was found that (1) about one-half the patients with transplants had antibodies in their pretransplant serum. The preexistence of antibodies directed against B lymphocytes had an unfavourable effect on the graft survival; (2) the graft did particularly well in the nonimmunized patients who had been previously transfused; the graft survival was about 80% at 3 years in these patients; and (3) the HLA (A, B) match influenced the graft survival only in patients with antibodies.

Some enzymatic and metabolic activities of normal human erythrocytes treated in vitro with cephalothin

Abstract S.FERRONE, A.ZANELLA, F.MERCURIALI and C.PIZZI, Some enzymatic and Metabolic activities of normal human erythrocytes treated in vitro with cephalothin , European J. Pharmacol. 4 (1968) 211–214. The incubation in vitro of normal blood with cephalothin, under suitable experimental conditions, produces a positive direct Coombs test. Some enzymatic and metabolic activities of normal human red cells treated in vitro with cephalothin were investigated. Treated red cells showed low acetylcholinesterase activity and low O 2 uptake in the presence of methylene blue; the content of reduced glutathione,the stability of reduced glutathione, the activity of glucose-6-phosphate dehydrogenase and of glutathione reductase, as well as lactic acid production in the presence of glucose however were found to be normal. These results are discussed. Positive direct Coombs test erythrocytic acetylcholinesterase activity

Evaluation Of The Blood Transfusion Policy Of The North Italy Transplant Program

A retrospective investigation carried out on the results of the 319 first cadaver kidney transplants performed from 1972 to 1977 in the North Italy Transplant Program (NITP) had indicated that graft survival was significantly better in transfused than in nontransfused patients (64% versus 47% at 2 years, P < 0.05) and was particularly good (80% at 3 years) in those transfused patients who had not produced lymphocytotoxic antibodies even if the HLA match was not particularly good. These data prompted a transfusion policy (starting January 1, 1978): the patients receive 3 units of packed red blood cells at 15-day intervals. A good HLA match is mandatory only for immunized recipients. This policy was expected to improve the results of the transplantation program while reducing the costs of organ sharing. The results of the 165 cadaver kidney transplants performed from January 1978 to June 1980 have confirmed the expectation. They can be summarized as follows: 1. Kidney graft survival has increased significantly (from 50 to 65% at 2 years); in transfused patients it is close to 70% as expected. 2. Kidney graft survival is better in transfused non-immunized patients than in those who have produced lymphocytotoxic antibodies (71% versus 62% at 2 years). 3. A good HLA-A,B match seems important particularly for immunized recipients. No firm conclusion can still be drawn insofar as the influence of the HLA-DR match on graft survival is concerned. 4. A positive B cell crossmatch (carried out at 22 C after platelet absorption) seems to have a detrimental effect on graft survival. 5. Peroperative transfusion, if effective, is not as effective as pretransplant transfusions in improving the graft survival. 6. The incidence of immunized recipients after three deliberate transfusions is acceptable, but because of the unrestricted use of blood transfusions in dialysis units (in addition to those given deliberately) the incidence of immunized and hyperimmunized patients in the waiting list is growing and this is particularly evident in female patients with previous pregnancies. The liberal use of blood transfusions must be halted to prevent an ever higher proportion of patients to become excluded from transplantation.

The in Vitro Lysis of the Red Cells of Paroxysmal Nocturnal Haemoglobinuria by the Serum of Patients with Cirrhosis of the Liver

The complement (c′) titre, the concentration of the third component of C’ (c′3) and the capacity of sera to lyse PNH cells in the acidified‐serum test and the sugar‐haemolysis test have been determined on the sera obtained from 100 healthy subjects and 103 patients with cirrhosis of the liver.

Study of Two in Vitro Diagnostic Tests for Paroxysmal Nocturnal Haemoglobinuria

Summary. The variability with time of the serum haemolytic activity of normal subjects in the acidified‐serum and sucrose‐haemolysis tests towards the red cells of paroxysmal nocturnal haemoglobinuria (PNH) and PNH‐like cells (i.e. normal red cells treated in vitro with the sulfhydryl compound AET) was investigated. A wide variability was observed in samples of serum obtained from individual donors at intervals of months, days, and even hours, without evidence of a circadian rhythm. In spite of this variability each donor of serum, considered in respect to other donors, maintained unchanged with time his rank of serum haemolytic activity towards both PNH and AET cells in the acidified‐serum test, but not in the sucrosehaemolysis test. From the practical point of view it seems convenient for the laboratory diagnosis of PNH to carry out acidified‐serum tests with the serum of one selected normal subject (in addition to the patients own serum) and sucrosehaemolysis tests with a few random normal sera.

Study of in Vitro Lysis of Paroxysmal Nocturnal Haemoglobinuria (PNH) and PNH‐like Red Cells

Summary. In paroxysmal nocturnal haemoglobinuria (PNH) the intensity of haemolysis obtained in the acidified‐serum and sucrose‐haemolysis tests—the two procedures most commonly used for the laboratory diagnosis of the disease—varies according to the red cells, serum and test used. The influence of these three variables has been investigated on both PNH and PNH‐like lysis, that is lysis of PNH cells and of normal red cells treated in vitro with the sulphydryl compound 2‐aminoethylisothiouronium bromide (AET). The conclusions, almost identical for PNH and AET lysis experiments, suggest that for the laboratory diagnosis of PNH: (1) it is advisable to use both tests in parallel; (2) sera to be used in the two tests should be selected; (3) for this selection AET cells can be employed when PNH cells are not available.

In-vitro lysis of AET-treated normal red cells (PNH-like cells) by normal and cirrhotic sera.

Summary. The total complement (C′) titre, the concentration of the third component of C (C′3) and the haemolytic activity against AET‐treated cells (PNH‐like cells) of normal and cirrhotic sera have been investigated. Serum haemolytic activity has been judged by the amount of haemolysis obtained in two in‐vitro tests, the acidified‐serum test and the sugar‐haemolysis test. A significant correlation has been found between total C’ titre and C′3 concentration of cirrhotic sera and the serum haemolytic activity against AET cells in the sugar‐haemolysis test.