Thoracic duct drainage and antilymphocyte globulin for renal transplantation in man

Thoracic duct drainage resulting in a lymphocyte depletion of more than 20 x 10(9) cells was performed during the three months prior to transplantation in 37 patients. Results obtained in this group of patients were compared to those in transplant recipients similarly treated, over the same period, but not subjected to thoracic duct drainage. Both groups received comparable doses of antilymphocyte globulins, azathioprine and corticosteroids. No clear-cut difference in transplantation outcome was found when recipients of kidneys from related living donors (whether HLA identical or HLA haploidentical) were considered. By contrast, an improved transplant survival and a decreased incidence of rejection crises were observed in recipients of kidneys from cadaver donors when a thoracic duct drainage was performed prior to transplantation. The immunosuppressive effect of thoracic duct drainage, probably enhanced by antilymphocyte globulin treatment, is therefore a valuable adjunct to more conventional methods of pretreating human cadaveric transplant recipients.