Optimization of living-related renal transplantation success through HLA genotyping, MLC stimulation cutoffs, and donor-specific blood transfusions

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A simple plan for selecting the optimal available living-related donor by means of HLA genotyping, mixed lymphocyte culture (MLC) stimulation cutoffs, and recently donor-specific blood transfusions (DST), has evolved from experience with 112 living-related donor recipient pairs. The approach was straightforward and ranked donor-recipient pairs as follows: Group 1: HLA-identical MLC non-stimulatory donors were preferred when available; these were almost always siblings, but HLA-identical MLC nonstimulatory parent-child combinations occurred as well.1Group 2: If no HLA-identical donor was available, then donors with low two-way MLCs (stimulation index <10) were selected.2, 3 Finally, if only an HLA-nonidentical donor with high MLC stimulation was available, then donor-specific transfusions (DST) were used (Group 3a)4 in order to improve the unsatisfactory results reported with high MLC stimulators before DSTs were introduced (Group 3b). 2, 3


Antigens of the HLA-A, B, and C loci antigens were tested by the standard microcytoxicity technique.5 Serologic testing for DR antigens 1 through 8 was carried out with anti-human F(ab)2 separation of B lymphocytes and the standard microcytotoxicity technique of the Eighth International HLA Workshop.5 Platelet-absorbed recipient serum was tested at 5, 22, and 37C against separated donor T and B lymphocytes5 before each DST, as well as before and after transplantation. Antibodies against monocytes and polymorphonuclear (PMN) leukocytes were detected with fluorochromasia.6 Mixed lymphocyte culture (MLC) and suppressor assays were performed as previously published.7 The suppressor assay was based on the reduction of one-way MLC stimulation by concanavalin-treated recipient lymphocytes, and the percent suppression was calculated as: . . .



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