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. 1979 Mar;11(1):276-84.

Thoracic duct drainage in organ transplantation: will it permit better immunosuppression?

T E Starzl, L J Koep, R Weil 3rd, C G Halgrimson, J J Franks

Thoracic duct drainage in organ transplantation: will it permit better immunosuppression?

T E Starzl et al. Transplant Proc. 1979 Mar.
No abstract available

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Figures

Fig. 1
Fig. 1
Use of thoracic-duct fistula 4 weeks after orthotopic liver transplantation for chronic aggressive hepatitis. The ability to drastically reduce steroids allowed the patient's wound and lung infection to be brought under control while, at the same time, liver function slowly improved. The centrifuged and cell-free lymph was reinfused intravenously.
Fig. 2
Fig. 2
Course after orthotopic liver transplantation for chronic aggressive hepatitis. Thoracic-duct drainage was started on the day of operation, and the cell-free lymph was reinfused intravenously thereafter. Note: (1) reduction of lymphocyte percent in peripheral blood during thoracic-duct fistula (however, the total lymphocyte count was not much affected because of the concomitant increases in total white count); (2) persistence and late resurgence of total thoracic-duct lymphocytes removed and of the T-cell component of these lymphocytes; (3) profound reduction of serum immunoglobulins while on thoracic-duct drainage.
Fig. 3
Fig. 3
Cadaveric renal transplantation without a definite rejection. The thoracic duct fistula was maintained for almost a month. Note that the number of lymphocytes removed from thoracic-duct lymph was actually greater at the end than at the beginning of thoracic-duct drainage. The depression of serum immunoglobulin is typical of thoracic-duct drainage, even though the cell-free lymph is reinfused.
Fig. 4
Fig. 4
Moderately severe renal homograft rejection that occurred in spite of thoracic-duct drainage and depended on intensification of prednisone therapy for reversal. Note that the total lymphocytes removed per day was greater at the end of thoracic-duct drainage than at the beginning.
Fig. 5
Fig. 5
Course of a patient who received two kidney and two pancreas transplants. The first two kidneys and the first pancreas were rejected. The patient had a strongly positive cytotoxic crossmatch against lymphocytes of the second pancreatic donor, but in spite of this, the organ has functioned perfectly. Note the cessation of insulin requirements from day 18 onward.
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