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March 16, 1970

Thoracic Duct Lymphocyte Depletion for Renal Allografts

JAMA. 1970;211(11):1847. doi:10.1001/jama.1970.03170110053012

It is currently held that renal allografts may be rejected by three different mechanisms.1 (1) The presence of preformed circulating cytotoxic antibodies which develop in response to previous exposure to allogeneic cells may lead to hyperacute rejection of renal allografts within a matter of minutes to hours following transplantation. (2) The acute rejection of renal allografts is thought to be mediated by the cellular immunological defense system composed of thymus-dependent lymphocytes. It is this form of rejection that largely determines the outcome of renal allografts during the first year following transplantation.3 As more experience has been gained with long-term renal allografts, it has become apparent that there is a chronic form of rejection that largely affects the arteries and glomerular capillaries of the allograft, This form of rejection is thought to be mediated by antibodies directed toward the vascular endothelium and appears in the second or third year