Ramon Patel

Crossmatch tests of the prospective kidney-transplant donor's lymphocytes with the serum of the prospective recipient in 225 transplants showed that eight of 195 with negative crossmatch failed to function immediately, in contrast to 24 of 30 with positive crossmatch (p less than 0.001). Immediate failure occurred in significantly higher numbers among patients with a higher risk of having antibodies, such as multiparous females and patients receiving secondary transplants. The effect was not a nonspecific one, for more immediate failures occurred among transplants from unrelated than among those from related donors. The corresponding frequency of positive crossmatch was also lower among related donors. The presence of preformed cytotoxic antibodies against the donor appears to be a strong contraindication for transplantation.

A 57-year-old male developed hypomagnesemia, hypokalemia and hypocalcemia during the course of repeated gentamicin therapy. Renal wasting of magnesium and potassium was demonstrated. Associated endocrine abnormalities included decreased level of serum immunoreactive parathyroid hormone and increased levels of plasma renin and aldosterone. Our findings are compared to those previously reported by other investigators.

TWO recent developments have greatly changed the outlook of histocompatibility testing in clinical kidney transplantation. The first is the dramatic advances made in the area of serologic typing of leukocytes. The Third Histocompatibility Testing Workshop held in Torino, Italy, in June, 1967, showed that many laboratories are now identifying the same leukocyte antigens with considerable precision and that these antigens for the most part belong to a single complex system called HL-A.1 The second development has been the accumulation of evidence that these antigens function as histocompatibility antigens influencing kidney function, renal histology2 and survival of transplants3 from related donors. . . .

MANY kidney-transplant recipients have preformed antileukocyte antibodies as a result of previous blood transfusions, kidney transplants or pregnancy.1 When these antibodies are specific for the donor's leukocytes (as indicated by a positive crossmatch test of the recipient's serum and the donor's cells), immediate failure of the transplant is highly probable.2 , 3 Even if these cases are excluded, however, it is our clinical impression that results of kidney transplantation in sensitized recipients are inferior to those in unsensitized recipients. Our analysis of 84 kidney transplants in 79 recipients performed between February 2, 1966, and December 18, 1970, appear to support this impression. . . .