Vascular localization of immunoglobulin IgM in a renal homotransplant

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IT is generally accepted that the rejection of renal homografts, in experimental animals and in man, is mediated by cellular rather than humoral immune mechanisms. Thus, immunologically competent cells from the recipient have been demonstrated to be in close contact with the vascular endothelial cells of the donor graft, thereby suggesting their role as graft-rejection cells.1 The role of humoral antibodies in graft rejection is not so well documented. Recently, the presence of humoral antibodies produced in response to renal transplantation has been demonstrated by various technics.2, 3 Immunofluorescent technics have been particularly useful in this respect, and, in most of the studies reported,4–6 the immunoglobulin localized in arterial vessels and glomeruli of the renal homograft has been IgG. We are reporting a case in which the renal homograft showed a striking deposition of the immunoglobulin IgM in the walls of small arteries, suggesting to us a possible role for this immunoglobulin also in the graft rejection reaction. This, to our knowledge, is the first reported example of IgM localization in a renal homograft.

Report of a Case

Clinical history. A 56-year-old Caucasian m an received a renal homotransplant from a cadaver donor on August 2, 1964, because of progressive renal failure of 2½ years’ duration. The patient’s primary renal disease was chronic pyelonephritis associated with severe hypertension. The blood group of the cadaver donor was AB positive and that of the recipient was A positive. After transplantation, there was a period of oliguria lasting about seven days, after. . .



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