LATE FOLLOW-UP AFTER THORACIC-DUCT DRAINAGE IN CADAVERIC RENAL-TRANSPLANTATION

Abstract

Thoracic duct drainage was added to conventional immunosuppression with azathioprine, prednisone and, sometimes, antilymphocyte globulin in 83 patients given cadaveric kidneys, including 65 primary graft recipients. The most effective use of thoracic duct drainage was for pretreatment. Optimal conditioning was at least 4 wk duration, and when lymph drainage was this long, the incidence of rejection during the 1st 3 postoperative mo. was reduced to 4.5%. Shorter pretreatment or institution of thoracic duct drainage contemporaneous with transplantation were less effective, but the 1 yr results were still better than those with conventional immunosuppression alone. The advantage gained with thoracic duct drainage during the 1st yr was diminished in all the treatment groups by graft losses in the 2nd postoperative yr. Without better maintenance therapy, the full value of temporary early lymphoid depletion procedures cannot be fully exploited.