Doctor of Philosophy
Anatomy & Neurobiology
Richard J. Weymouth
In recent years renal homotransplantation has become more frequently used in the treatment of terminal renal disease in man. By carefully selecting donors with the aid of tissue compatibility tests and employing immunosuppressive drugs, these transplants have become increasingly more successful. It is true, however, that even with good tissue match-up and drug treatment rejection episodes occur, frequently within the first two-postsurgical weeks. The majority of these rejection crises may be reversed by increasing drug dosages and occasionally applying x-irradiation to the area of the transplant. In other cases rejection by the recipient is responsible for cessation of function of the transplanted kidney, terminating in its ultimate removal.
Millard et al. (1970) suggested that light microscopic studies of biopsy tissue Obtained from transplanted kidneys at various intervals postoperatively would be useful in early clinical management of the patients. The primary purpose cf the present study is to determine if electron microscopic studies of renal tabules in tissue obtained one hour postoperatively would also be useful in indicating subsequent graft rejection or dysfunction.
Light (Dempster, 1952; Simonsen et al., 1952; Porter et al., 1964; and Shorter et al., 1964) and electron microscopic (Darmady et al., 1955; Kountz et al., 1963; Porter et al., 1964; and Williams et al., 1964) observations of canine homotransplanted kidneys are numerous but none of the biopsies studied were obtained prior to six hours post-transplantation.
Ultrastructure of normal human kidney has been described (Rhodin, 1958; Flume et al., 1963; Brewer, 1965; Myers et al., 1966; Tisher et al., 1966; Bulger et al., 1967; and Tisher et al., 1968) as has the ultrastructure of normal monkey renal tubules (Tisher et al., 1969). Electron microscopic studies of human renal homotransplanted tissue including the glomerulus, tubules and vasculature have also been reported. However, the majority of the biopsies described were Obtained one week or more following transplantation (Hamburger et al., 1965; Porter et al., 1966; Shimamura et al., 1966; and Busch et al., 1971).
Hume et al. (1970) included one hour biopsies in their studies of glomerulonephritis. Weymouth et al. (1970) described the ultrastructure of the glomerulus one hour post-transplantation and.were able to correlate changes in the glomerulus with future function of the transplant. Electron.microscopic studies of the tubules, vasculature or interstitium one hour after transplantation have not been previously reported.
Therefore, it seemed pertinent to study these tissues, correlating structure with clinical function in an effort to determine if this information could be used to postulate the future of the individual renal transplant.
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