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Harry E. Sarles, MD; August R. Remmers, Jr., MD; Jay C. Fish, MD; Carlos O. Canales, MD; Frank D. Thomas, MD; Kenneth R. T. Tyson, MD; Gerald A. Beathard, MD; Stephan E. Ritzmann, MD

Arch Intern Med. 1970;125(3):443-450.

Abstract
Fourteen patients with uremia received 17 cadaveric renal allografts following lymphocyte depletion by means of thoracic duct cannulation. As depletion progressed, marked lymphocytopenia appeared, large lymphocytes appeared in the lymph, peripheral lymphoid tissues became depleted in the thymus-dependent areas, immunoglobulin levels remained constant, and delayed hypersensitivity skin responses disappeared. Renal allografting was performed following the removal of as few as 10 x 10⁹ and as many as 331 x 10⁹ lymphocytes. Immunosuppressive drugs were not administered unless allograft rejection occurred or the patient was discharged from the hospital. Little evidence of rejection was noted for as long as 78 days following transplantation. Excellent renal function is maintained in all but one of the nine survivors. The depletion of circulating lymphocytes prior to renal allotransplantation appears to selectively suppress cellular immune defenses and enhance graft survival without seriously depressing humoral defenses.

Author Affiliations
Galveston, Tex

From the Division of Nephrology, Department of Medicine (Drs. Sarles and Remmers); the Department of Surgery (Drs. Fish and Tyson); the Department of Medicine (Drs. Canales and Thomas); the Department of Pathology (Dr. Beathard); and the Division of Hematology-Immunology (Dr. Ritzmann), Shriners Burns Institute, University of Texas Medical Branch, Galveston. Drs. Canales and Thomas are fellows in Nephrology, Dr. Beathard is a fellow in Experimental Pathology, and Dr. Ritzmann is a Leukemia Society Scholar.

Footnotes
Received for publication Sept 10, 1969; accepted Nov 12.

Read in part before the Central Society for Clinical Investigation, Chicago, Nov 22, 1968; and International Congress of Nephrology, Stockholm, June 27, 1969.

Reprint requests to Department of Internal Medicine, University of Texas Medical Branch, Galveston 77550 (Dr. Sarles).

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