HL-A haplotypes and unexplained infertility.
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Twenty-two patients on chronic hemodialysis were tested for direct lymphocyte-mediated cytotoxicity (DCML) and antibody-dependent lymphocyte-mediated cytotoxicity (LALI) against selected panels of normal donor lymphocytes. The DCML reaction was only positive in patients who had received blood transfusions within the two or three months prior to testing. Thus this reaction has limited value in practice as a parameter for presensitization. The use of third-party effector cells and of target cells precoated with antibody in the LALI reaction was evaluated, and it is advocated that effector cells from the patient investigated and direct application of patient serum to reaction mixtures should be preferred in order to avoid false negative reactions. In patients who had once manifested lymphocytotoxins, LALI disclosed a much broader reactivity than seen with a conventional complement-dependent cytotoxicity technique (CDC), whereas in this study patients who had never developed cytotoxins were also negative with the LALI technique. It is concluded that a positive LALI cross-match, in spite of a negative CDC cross-match, will be a common finding in donor-recipient combinations where the recipient has preformed cytotoxins. The effect of this on subsequent graft prognosis needs further clarification.
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A two-stage procedure is described for cytotoxicity tests in which three different sera from a prospective kidney recipient are pooled in each well of a standard microcytotoxicity test plate. The results are reproducible and as sensitive as those obtained with single sera tests. The technique permits a reduction in time required for a test and the number of wells that must be evaluated to screen a series of sera. It enables a laboratory to run all available sera on patients for cadaver kidney crossmatching and to eliminate hyperacute rejections. Serum pooling may also be used for screening of many sera against random cell panels.
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This paper establishes that HLA antigens can be detected in serum by lymphocytotoxicity inhibition. A score system is described which enables the degree of cytotoxicity inhibition to be quantitated. The following HLA antigens have been detected: A1, A2, A3, A11, Aw24, B5, B7, B8, B27, Bw35 and B40. It has not been possible to detect HLA-B12.
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