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  • McWhinnie DL
  • Fuggle SV
  • Thompson JF
  • Wood RF
  • Morris PJ
Tissue Antigens. 1987 Apr;29(4):214-23 doi: 10.1111/j.1399-0039.1987.tb01579.x.

The influence of donor and recipient HLA-A,B and -DR matching on the cellular infiltration in renal allografts was examined in 78 transplant recipients who received either cyclosporin (Cy) or azathioprine and low-dose prednisolone (AP) immunosuppression. Transplant biopsies (n = 161) were routinely obtained up to 40 days after transplantation, and biopsy material was therefore available from both rejecting grafts and grafts with stable function. Tissue sections were labelled with a panel of monoclonal antibodies and stained using an indirect immunoperoxidase technique. Cellular infiltration was assessed using a morphometric point counting technique. In AP-treated patients with well-functioning grafts, poor HLA-AB and HLA-DR matching was associated with increased leucocyte infiltration, while in patients receiving Cy therapy the effect of matching on cellular infiltration was seen only during rejection in grafts poorly matched for HLA-AB antigens. In addition, where an effect of HLA-AB matching on cellular infiltration was found, CD8+, but not CD4+ cells, were significantly increased in number, while when an HLA-DR matching effect was seen, a significant increase was observed in the CD4+ and not the CD8+ infiltration. Thus, HLA matching may influence the magnitude of the cellular response in renal allografts and the phenotype of the infiltrating cells.

  • Friedman J
  • Barnes L
  • Sheahan M
  • Tsai H
  • Goldstein G
Transplant Proc. 1987 Apr;19(2 Suppl 2):46.
  • Morris PJ
  • Chapman JR
  • Allen RD
  • Ting A
  • Thompson JF
  • et al.
Lancet. 1987 Mar 14;1(8533):586-91 doi: 10.1016/s0140-6736(87)90233-9.

129 patients who received a cadaver renal transplant entered a randomised prospective trial of cyclosporin for 3 months with conversion to azathioprine and prednisolone compared with conventional therapy of azathioprine and prednisolone. In the 64 patients who received cyclosporin, actuarial patient survival was 92%, and actuarial graft survival was 72% and 67% at 1 and 4 years after transplantation. Graft survival was significantly better (p less than 0.03) than in the 65 patients who received conventional therapy, in whom actuarial patient survival was 94%, and actuarial graft survival was 59% and 47% at 1 and 4 years. Renal function and other side-effects improved quickly after conversion with the better renal function maintained throughout follow-up. Renal biopsies at 90 days and 1 year in all patients did not show consistent improvement after conversion from cyclosporin in the histological features that might be attributable to cyclosporin toxicity. After conversion, 32% of the patients had acute rejection, generally within 30 days. 1 graft was lost to early acute rejection after conversion and another was lost 3 months later from acute-on-chronic rejection. A total of 8 grafts were lost to chronic rejection in the cyclosporin-treated group and 6 in the conventional group. The improvement in renal function obtained with this protocol of short-term cyclosporin with conversion to azathioprine and prednisolone has to be balanced against the risk of acute rejection and even loss of the graft after conversion.

  • Hoitsma AJ
  • Wetzels JF
  • van Lier HJ
  • Berden JH
  • Koene RA
Lancet. 1987 Mar 14;1(8533):584-6 doi: 10.1016/s0140-6736(87)90232-7.

In a prospective randomised trial, 72 recipients of cadaver renal allografts received cyclosporin for 3 months followed by azathioprine and prednisone (cyclosporin group), and 71 received azathioprine and prednisone from the day of transplantation (conventional group). Graft survival was better in the cyclosporin group at 3 months and 1 year (93% and 80%) than in the conventional group (83% and 70%). This was not a significant difference. The incidence of acute rejection episodes in the first 3 months was significantly lower in the cyclosporin group (35% versus 77%, p less than 0.00001), as was the number of grafts lost because of immunological failure (1 versus 10, p less than 0.02). After conversion, renal function improved. Only 5 patients had acute rejection after conversion. These episodes were easily reversible in all cases and did not lead to graft loss. The numbers of grafts lost after conversion were similar in the two groups. Conversion of cyclosporin to azathioprine 3 months after renal transplantation is a safe procedure that obviates the long-term toxic effects of cyclosporin.

  • Wagner K
  • Neumayer HH
Med Klin (Munich). 1987 Mar 13;82(5):171-7.
  • Chou S
  • Kim DY
  • Norman DJ
J Infect Dis. 1987 Mar;155(3):565-7 doi: 10.1093/infdis/155.3.565.
  • Macleod AM
  • Hillis AN
  • Mather A
  • Bone JM
  • Catto GR
Lancet. 1987 Feb 21;1(8530):416-8 doi: 10.1016/s0140-6736(87)90121-8.

Non-cytotoxic and cytotoxic antibodies were sought after donor-specific transfusion (DST) in 12 potential renal transplant recipients given concomitant cyclosporin therapy and 13 given DST alone. Non-cytotoxic antibodies, which have been shown to develop after third-party transfusion and to be associated with successful transplantation, developed after DST whether or not cyclosporin was given. Donor and panel reactive lymphocytotoxic antibodies developed relatively infrequently after DST with or without cyclosporin. Donor-specific sensitisation occurred only in patients who were multiparous or had over 10 third-party transfusions. Non-cytotoxic Fc-receptor-blocking antibodies may play a part in the improved survival of one-haplotype-mismatched transplants pretreated with DST.

  • Stoffel M
  • Squifflet JP
  • Pirson Y
  • Lamy M
  • Alexandre GP
Transplant Proc. 1987 Feb;19(1 Pt 3):2190-3.
  • Lundgren G
  • Albrechtsen D
  • Brynger H
  • Flatmark A
  • Frödin I
  • et al.
Transplant Proc. 1987 Feb;19(1 Pt 3):2074-9.
  • Mendez R
  • Mendez RG
  • Koussa N
  • Cats S
  • Bogaard TP
  • et al.
Transplant Proc. 1987 Feb;19(1 Pt 3):2047-50.