[Restoration of mixed and severe immunologic deficiency, by fetal liver and thymus graft]

A male infant with severe combined immunodeficiency but normal adenosine deaminase activity for whom no suitable bone marrow donor was available was given two separate grafts of both hepatic and thymic cells, the cells for each graft being taken from the same fetus aged 13 and 10 weeks respectively. Cell mediated and partial humoral immunity was restored 330 and 400 days respectively after the second transplant. No graft-versus-host reaction was observed and both red blood cell and lymphoid chimaerism could be demonstrated. The child was kept in strict bacterial isolation from the 3rd to the 537th day of life. Thirty months after the graft, the infant is in good health but has a defect of neutrophil chemotaxis and phagocytosis which requires prophylactic benzathine penicillin in addition to gammaglobulins. Fetal tissue transplantation may provide an alternative treatment for patients with severe combined immunodeficiency who do not have a histocompatible donor.