HOMOGRAFT REJECTION IN CHILDREN WITH CONGENITAL IMMUNOLOGICAL DEFECTS

Abstract

Skin homografts were rejected by 4 children with rare congenital defects of protein synthesis, associated with susceptibility to recurrent bacterial infections. Test homografts were used to clarify the immuno-logic defect in these children, 3 of whom had congenital agammaglobulin-emia and one of whom had Aldrich syndrome. All 4 were lacking in iso-hemagglutinins. Rejection of homografts by these patients can be taken as evidence that neither gamma globulin nor isohemagglutinins are primarily concerned in the mechanism of transplant rejection in man. The widespread acceptance of the view that patients with congenital a-gammaglobulinemia cannot develop transplantation immunity may perhaps have helped to attach an undue emphasis to the importance of classical gamma globulin antibodies in the process of graft rejection. The prolonged survival of homografts previously reported in 2 agammaglobulinemic patients, and in one patient with normal gamma globulin levels but iso-hemagglutinin deficiency, must depend on some associated inborn error of protein synthesis or of immunological mechanisms which has so far gone unrecognized.