[The selection and surveillance of cadaver kidney recipients. Recent development in graft immunology (author's...

This study, based on results of 252 cadaver kidney transplantations, shows that some factors which reflect individual immune response capacity, such as ability to produce anti-HLA antibodies, sex and response to hepatitis B virus, appear, along with HLA compatibility, to markedly influence renal graft survival and leads us to propose the following new guide-line for cadaver kidney recipient selection: For "good responders" (i.e., patients with anti-HLA antibodies, females and HBs Ag negative individuals) a close HLA compatibility with the donor (3 or 4 antigens in common) is necessary, while this need not be observed for "non-responders" (i.e., patients without preformed anti-HLA antibodies, males and HBs Ag persistent carriers). Furthermore, review of recent methods proposed for detecting early cellular and humoral manifestations of rejection leads to proposal of the following immunological monitoring of the transplant recipient. Systematic and frequent testing for circulating cytotoxic cells and antibodies against donor antigens, regular dosage of complement factors and of the nephretic factor, and investigations for the migration leukocyte inhibiting factor and macrophage arming factor, possibly produced in vitro by lymphocytes. Both these protocols for recipient selection and immunological monitoring can henceforth be applied and may contribute to improve cadaver kidney transplantation prognosis.