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. 1963 Oct:117:385-95.

THE REVERSAL OF REJECTION IN HUMAN RENAL HOMOGRAFTS WITH SUBSEQUENT DEVELOPMENT OF HOMOGRAFT TOLERANCE

T E STARZL, T L MARCHIORO, W R WADDELL

THE REVERSAL OF REJECTION IN HUMAN RENAL HOMOGRAFTS WITH SUBSEQUENT DEVELOPMENT OF HOMOGRAFT TOLERANCE

T E STARZL et al. Surg Gynecol Obstet. 1963 Oct.
No abstract available

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Figures

Fig. 1
Fig. 1
Rejection crisis in Patient 1. Note transient oliguria, depression of creatinine clearance, and elevation in blood urea nitrogen, blood pressure, and urinary protein excretion. The changes were all reversible. The patient previously had undergone bilateral nephrectomy, splenectomy, and thymectomy. R, Dose total body irradiation; Acti-C, actinomycin C, each arrow equals 200 micrograms of actinomycin C administered intravenously. Imuran is synonymous with azathioprine.
Fig. 2
Fig. 2
Rejection crisis in Patient 2. Note temporary deterioration of renal function, coincident with fever and weight gain starting on the twenty-fifth day after transplantation. The patient was essentially anuric for 3 days. Acti-C, Actinomycin C, each arrow equals 200 micrograms; D, diaysis. Imuran is synonymous with azathioprine.
Fig. 3
Fig. 3
Rejection crisis in Patient 6. Deterioration of renal function began 19 days after transplantation. All stigmas of rejection are present except for acute hypertension and weight gain, which were successfully prevented by medical treatment. Acti-C, Actinomycin C; LN, left nephrectomy at time of transplantation; RN, right nephrectomy. Imuran is synonymous with azathioprine.
Fig. 4
Fig. 4
Course of Patient 4, the only patient who received large continuous prophylactic doses of prednisone from the time of operation. Despite provision of kidney by a genetically nonrelated donor, a definite rejection crisis did not occur. D, Dialysis; TS & BLN, thymectomy, splenectomy, and bilateral nephrectomy; Acti-C, actinomycin C, each arrow equals 200 micrograms of actinomycin C administered intravenously. Patient ultimately died of unrecognized intra-abdominal abscess.
Fig. 5
Fig. 5
Four minute intravenous pyelogram or Patient 2 on 23 February 1963, 24 days after renal transplantation to the right iliac fossa. Note prompt and concentrated dye excretion. Within 24 hours after this roentgenogram was taken, the patient experienced a severe rejection crisis and became essentially anuric. Recovery was ultimately complete.
Fig. 6
Fig. 6
Autopsy specimen of renal homograft in Patient 4. Renal function had been adequate until death from sepsis 113 days after transplantation. Note good preservation of renal architecture. Only a few scattered mononuclear cells were present. X 39.
Fig. 7
Fig. 7
Three minute intravenous pyelogram of Patient 1 on 28 January 1963, 9½ weeks after transplantation and 4 weeks after complete recovery from a rejection crisis. Note prompt and concentrated dye excretion in the kidney which is located in the right iliac fossa.
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References

    1. Balankura O, Goodwin WE, Murray JE, Dammin GJ. Surgical Forum; Clinical Congress 1960. XI. Chicago: American College of Surgeons; 1960. Study of the homograft reaction by retransplantation of the canine kidney; p. 24. - PubMed
    1. Calne RY, Alexandre GPJ, Murray JE. A study of the effects of drugs in prolonging survival of homologous renal transplants in dogs. Ann N York Acad Sc. 1962;99:743. - PubMed
    1. Calne RY, Murray JE. Surgical Forum; Clinical Congress 1961. XII. Chicago: American College of Surgeons; 1961. Inhibition of the rejection of renal homografts in dogs by Burroughs Wellcome 57-322; p. 118. - PubMed
    1. Goodwin WE, Kaufman JJ, Mims MM, Turner RD, Glassock R, Goldman R, Maxwell MM. Human renal transplantation – I, clinical experiences with 6 cases of renal homotransplantation. J Urol Balt. 1963;89:13. - PubMed
    1. Goodwin WE, Martin DC. Transplantation of the kidneys. J Urol Balt. 1963 spring; in press. - PubMed

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