Organ Homotransplantation Research Articles

PHENOMENON OF DEMIKHOV. In the Sklifosovsky Institute (1960–1986). Research Coordination Council of the USSR Healthcare Ministry: Missed opportunities. Part 2 (1963)

This paper has first put into scientific circulation the transcript of the Meeting of the Presidium of the USSR Healthcare Ministry Council for the Coordination of Scientific Research and Implementation of the Scientific Achievements that was held on October 8, 1963, and discussed the current state and development of scientific research in organ transplantation in the USSR. The presentations of the meeting participants who discussed the reports of V.P. Demikhova and V.I. Burakovsky have been described and analyzed. The concept of organ homotransplantation put forward by V.P.Demikhov who did not take into account (in some speakers's opinion) the latest achievements in immunobiology was reasonably criticized. V.I.Burakovsky's proposals on establihing a Research Institute of Organ and Tissue Transplantation and the Problem Commission for Transplantology were considered rational, supported, and included in the Presidium Resolution.

Progress in the determination of histocompatibility. 1965.

Experimental and clinical data currently available suggest that of the various possible ways in which the outcome of organ homotransplantation might be improved upon, the one which holds most immediate promise involves devising a selection procedure capable of excluding gross histoincompatibilities. The various approaches to the problem of tissue typing or matching that are presently being investigated are reviewed from the viewpoint of their underlying principles and their potentialities. These methods include direct grafting tests, serologic procedures aimed at matching or identifying pertinent isoantigenic specificities associated with formed elements of the blood, especially leukocytes, and various extracorporeal biologic assays of the capacity of an intended host's immunologically competent cells to react against the transplantation isoantigens of a possible donor. The latter category of tests includes the normallymphocyte transfer test and the irradiated-hamster test.

Cellular Aspects of Immune Reactions

During the last few years, a penetrating insight into the cellular basis of tolerance, hypersensitivity, and immunity has been obtained by the focus of anatomists, immunologists, biochemists, and clinical scientists upon these states. In this report, the study of blood cells, their origin and their function in relation to immunological reactions, is presented to demonstrate the substantial progress made in recent years. The recent surgical success of organ transplantation has intensified interest in the function of these cells. The results of basic research in the field of immune responses show great promise for practical application in promoting resistance to specific infections, advancing homotransplantation of organs and combating autoimmunity. A basic requisite for survival of living organisms is the recognition, isolation, and elimination of pathogenic agents. These functions are performed

Aneurysmal Degeneration of Femoropopliteal Arterial Homografts

The evanescent era of the arterial homograft began nearly 12 years ago and ended five years later in most centers. It is of interest to obtain a long-term evaluation of this method of arterial reconstruction not only to place it in its proper perspective but also because arterial homografts are once again being used. Organ homotransplantation entails homotransplantation of moderate and smaller-sized arteries which may be vulnerable to the same degenerative changes as the isolated arterial homograft. Thirty-five femoropopliteal arterial homografts have been reviewed, with the observation that all of the patent grafts have become aneurysmal. This finding has led us to believe that all similar-sized homografts that remain patent will eventually become aneurysmal. Clinical Material Arterial homografts were obtained from patients under 45 years of age who died following trauma or nonmalignant and noninfectious diseases. The grafts were removed under sterile conditions, placed in physiologic saline containing 500,000 units

Ureteropelvic Obstruction Caused by Candida Pyelitis in Homotransplanted Kidney

MUCH ATTENTION has recently been directed toward the occurrence of significant and often fatal infections following organ homotransplantation and immunosuppression. 1-3 Although pulmonary involvement seems to be the most common manifestation, it is apparent that genitourinary infection is also important, particularly after renal transplantation. We have recently been caring for a patient with a renal homotransplant who acquired a Candida albicans infection in the grafted kidney and on two occasions developed ureteral obstruction. In both instances, irrigation of the collecting system with an amphotericin B solution resulted in relief of the obstruction and elimination of the fungus from the urine. Report of a Case A 48-year-old man (UH 163254), developed progressive renal insufficiency due to chronic glomerulonephritis and was referred to Thomas E. Starzl, MD, at the University of Colorado Medical Center for consideration of renal homotransplantation. On Dec 7, 1963, renal homotransplantation was carried out, the patient's sister serving

Progress in the Determination of Histocompatibility

Experimental and clinical data currently available suggest that of the various possible ways in which the outcome of organ homotransplantation might be improved upon, the one which holds most immediate promise involves devising a selection procedure capable of excluding gross histoincompatibilities. The various approaches to the problem of tissue typing or matching that are presently being investigated are reviewed from the viewpoint of their underlying principles and their potentialities. These methods include direct grafting tests, serologic procedures aimed at matching or identifying pertinent isoantigenic specificities associated with formed elements of the blood, especially leukocytes, and various extracorporeal biologic assays of the capacity of an intended host's immunologically competent cells to react against the transplantation isoantigens of a possible donor. The latter category of tests includes the normallymphocyte transfer test and the irradiated-hamster test.

The Influence of Varying Dose and Repetitive Short Sessions of Extracorporeal Irradiation of the Blood on the Production of Lymphopenia

The capability of producing a marked and prolonged lymphopenia by extracorporeal irradiation (ECI) of the blood (1, 2), the prolongation in rejection of skin grafts (3), the development of a cobalt-60 irradiator to supplant the X-ray machine (4), and semipermanent Teflon-Silastic arteriovenous shunts have become realities. In the original experiments a transit dose of 900 rads was adapted, since the work of Trowell (5) led us to believe that this dose would approximate the 100 % lethal dose for lymphocytes. However, in some of the experiments with continuous ECI of the blood for 36 to 72 hours, severe hemolysis developed, owing to radiation injury of the red cells. This necessitated a fuller understanding of the factors that might contribute to an accumulation of sufficient dose to the red cells to produce hemolysis before ECI could be extended to the study and treatment of human disease. It had been demonstrated by Slatkin et al. (6) that one can estimate the dose distribution to any items that remain within the blood stream during ECI of the blood from the volume of the blood in the total bypass, the blood volume, the transit dose, and the total duration of ECI. By applying these mathematical principles to the specific cases in which hemolysis was induced, it was found that, when a substantial fraction of red cells had accumulated a dose in excess of 100,000 rads, hemolysis commenced. These studies (7) have in fact shown that 100,000 rads delivered to red cells in vitro will cause a major portion of them to be destroyed promptly on subsequent autotransfusion of the labeled cells into the donor. Prior to application of ECI in the treatment of leukemia in man or in the preparation of patients for homotransplantation of organs, one must know the best ECI treatment schedule to suppress the radiosensitive lymphocytes in the blood and how to minimize injury to the radioresistant red cells, because the ultimate duration of therapy

CLINICAL EXPERIENCE WITH ORGAN TRANSPLANTATION.

In this communication, the problems of tissue transplantation will first be surveyed as they apply specifically to the kidney and its function. As an experimental model, transplantation of this organ has unique advantages for the acquisition of knowledge which will undoubtedly have more general application. With renal homografts, the functional status of the kidney can be followed with precision, using the specific parameters of urine volume, blood urea nitrogen, creatinine clearance, urine protein and urea, and blood pressure. The onset of rejection can be defined with great accuracy. Inferential information concerning the mechanisms of tissue deterioration are available for analysis. The effect of agents used for the prevention or reversal of rejection can be determined unequivocally, since the transplanted kidney is essential for life and its function can be scrutinized on a moment-to-moment basis. Finally, the technical necessities of operation have much in common with those met with other organs such as the liver, inasmuch as the factors of ischemic injury, preservation of homograft, reconstitution of blood supply, and reconstruction of nonvascular visceral passages are all essential details in the transplantation of most organs. Having first surveyed progress with kidneys, we will then describe how such information has been extrapolated to hepatic and splenic whole organ homotransplantation within our own experience.

Plastic surgery: tissue and organ homotransplantation.

THE important observation of Medawar1 that a second homograft of skin from the same donor rabbit to the same recipient rabbit was rejected more rapidly than the first stimulated hope that perhaps a recognized biologic reaction could explain the mysterious individual tissue specificity originally theorized by Loeb.2 This evidence of a specific sensitization of the recipient by the donor tissue and the antigen–antibodylike reaction in the rejection of the transplant has been the impetus for a series of further investigative projects on both sides of the Atlantic. Among the earliest technics of study was parabiosis (1860),3 the physical union between . . .