Organ Transplantation 1990
This volume is based on a very successful meeting on organ transplantation that was held in Kuwait in 1990 under the auspices of the Middle East Society for Organ Transplantation. An international group of organ transplant experts attended this conference
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DEVELOPMENTSINSURGERY VOLUME Il
The titles published in rhis series are lisred at rhe end of rhis l'o/ume.
ORGAN TRANSPLANTATION 1990 edited by
G.M.ABOUNA M. S. A. KUMAR (Associate Editor) and
A. G. WHITE (Associate Editor) Department of Organ Transplantation Kuwait University Kuwait City, Kuwait
and The Division of Transplantation Department of Surgery Hahnemann University Philadelphia, PA. U.S.A.
SPRINGER-SCIENCE+BUSINESS, MEDIA, B.V.
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of Conllrus Clta lOllln ll- ln - Publlcltlon DIU
Organ Tr,Mphntatlon 1990 I eCllted by 0.1".. Aboun" H.S. A. KUllr. A. O. HhHe. p. el. -- 6 months) results from chronic rejection, characterized by the gradual narrowing of blood vessels with deposition of fibrin in the internallumen. Vascular endothelial cells have been shown to have class 1 antigens, but are conspicuously lacking in class II antigens (21).
25 6-month Half-life survival > 6 mos (±se,%) (± se, years)
First grafts OMM( 34) IMM( 54) 2MM( 154) 3MM(3O.:J) 4MM(476) 5MM(524) 6MM(382) 7MM( 157) 8MM( 31)
tii > .~
::J
cn
=...ro (!)
0.7 0.6 0.5 0.4 O
6
12
24
36
pvalue
48
71.4±8.2 87.0±4.6 82.3±3.1 80.7±2.3 79.4± 1.9 82.6j- 1.7 n.8j-2.2 7S.6j-3.4 64.2±8.7
ONS ONS 13.1±4.2 10.1±2.0 7.3j-1.1 6.1j-O.8 7.6j-1.3 6.0j-1.S
ONS
N.S.
Regrafts 1.0
tii > .~
::J
cn
=...ro (!)
OMM( 8) 1MM( 15) 2MM( 2!J) 3MM( 62) 4MM(84) 5MM( 75) 6MM(S3) 7MM( 22) 8MM( 8)
0.9 0.8 0.7 0.6 0.5 0.4 O
6
12
24
36
48
pvalue
100 66.7j-12.2 71.8j-8.5 69.0j-S.9 66.6±S.2 S9.6j-S.7 56.Sj-6.8 n.3j-8.9 20.0j-17.9
N.S.
Months Posttransplant Fig. 6. Cumulative graft survival by ABCDR mismatches.
During chronic rejection, binding of class 1 antibodies to the endothelium initiates the cascade of events resulting in luminal obliteration (22). Thus, early acute rejection is most likely produced by cytotoxic T cells against class II antigens and late chronic rejection is produced by antibodies to class 1 differences on endothelial cells. Although the acute and chronic phases are not clearly demarcated, there is a sharp inflection in survival curves at 3-6 months post-transplant. We as sume that this is the time when the target of the immune response and the character of the response shifts. Interestingly, this inflection point in the older data was at 1 year for cadaver donor transplants (23), and has gradually become shorter in the newer data. For living-donor grafts, the change occurred at 3 months in the earlier and current data. Data presented here shows that the A-locus and B-locus products are independent and additive. That is, increasing mismatches for the A or B locus adds to increase the rate of long-term loss. This may indicate that the products of these 2 loci exist separately on the endothelial cells and are subject to additive attack by antibodies. It appears that mismatches in the C locus may also be additive. As shown in Figure 6, 8 antigens of mismatch, which includes
26 the C locus, led to the lowest survival rate in both first and regrafts. Although the numbers were small, the suggestion is that even the C
