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HL-A typing has proved to be a poor predictor of kidney compatibility (1). It has been claimed that genes determining mixed lymphocyte culture (MLC) are apart from those of HL-A (2). Considering cellular processes in the induction phase of rejection mechanism, MLC would seem to be a logical tool for donor selection.
MLC was studied in 42 patients with kidney and 9 patients with liver transplantation. Kidney recipients were divided into primary related (19 patients), primary unrelated (14 patients) and secondary or multiple unrelated transplants (9 patients). None of the first two groups, but all of the last group were under immunosuppression at the time of MLC. Follow-up studies are for one to nine months after transplantation, excluding no patients. Rejection was diagnosed pathologically and by positive findings on two consecutive days of three clinical laboratory tests (blood urea nitrogen, creatinine clearance, and urine sodium concentration for kidney; serum bilirubin, transaminases, and alkaline phosphatase for liver). MLC was performed by Bach's method (3) with modifications. Stimulation index (SI) of MLC was defined by the ratio between the reaction of recipient cells to mitomycin-C-treated donor cells and that to mitomycin-C-treated recipient cells. A SI lower than 10 was considered compatible; those with SI higher than 10 were designated incompatible.
The results (Table 1) indicated a positive although imperfect correlation between one-way MLC and the clinical course after primary kidney transplantation, either related or unrelated. A good MLC match was much more common than good HL-A matching. Similar findings have been reported by other authors (4,5), although they have used two-way MLC. Except for the double haplotype identical sibling cases, there was no correlation between HL-A and MLC. Even among these sibling cases there were two patients who rejected kidneys despite an identical HL-A and MLC. This finding and the report of Seigler and associates (6) suggests the possibility that minor incompatibilities may have been responsible. Immunosuppressive therapy apparently affected the MLC results, and the potential ability of the recipient to reject the graft was not adequately expressed by the MLC (Table 1). With liver transplantation, there has not yet been a correlation between outcome and MLC.
Supported by research grants from the Veterans Administration and by National Institutes of Health grants A1-AM-08898, AM-07772, RR-00051 and RR-00069.