[Immunologic and transplantation biology studies in patients with terminal renal failure]

Best possible tissue compatibility is a fundamental precondition for a successful organ transplantation. The desirable tissue compatibility is mainly defined by transplantation-antigens of the donor and the recipient and therefore--beside ABO antigens--the characteristics of HLA-system are the focal point of the preoperative immunological diagnosis. Based on the results of comperative examinations it is demonstrated, that HLA-antisera have such a widespread biological variability, that they lead sometimes to a faulty diagnosis which in turn causes the biological importance of the HLA-system to be doubted. The preoperative immunologic diagnosis should include an estimation of the risk factors in the patient. The consideration of the crossmatch between donor and recipient is a decisive factor in organ transplantation. The starting point is the preoperative antibody monitoring which checks the patients serum reactions against a panel of blood donors to see, whether the patient is a "high" or "low"-- responder to allogenetic stimuli. A positive reaction in the crossmatch is brought about by different kinds of antibodies whereby only in the presence of auto-antibody or cold-reactive B-cell antibody a transplantation may take place. The antibody characterisation in preoperative diagnosis is supported by the results of the immunologic antibody monitoring, whereby--because of the results here presented-- it can be confirmed, that through the knowledge of the antibody specifities which have been checked in a positive crossmatch transplantation on highly sensitized patients can take place with a prospect of success. Supplementing the "Eurotransplant" results the HLA-DRw6 antigen is shown not only to be an indication of risk in transplantation, but may also be an aetiopathogenetic factor. In the presentated statistics it can be shown, that in patients suffering from glomerulonephritis or pyelonephritis and requiring dialysis treatment the HLA - DRw6 antigen occur more frequently than in the control group of healthy blood donors. In glomerulonephritis patients there is additionally a significant change in distribution favourable to HLA - DRw10 shown. The determination of genetically caused risk factors is appreciably supported by characterisation of lymphocyte subpopulations and diagnosis of changes in the Complement-system. Changes in T-lymphocyte subpopulations pointing to proceedings of immunostimulation and conditions of the activated Complement-system represent warning signals in organ transplantation.