Clinical histocompatibility testing--1979. Proceedings of the fifth annual meeting of the American Association for Clinical Histocompatibility Testing.
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The disparity index is an expression of histocompatibility difference between two siblings with identical human leukocyte antigen (HL-A) type who are nonreactive in mixed leukocyte culture (MLC) test. This index is derived from a third-party MLC test. The disparity index was found to be correlated with the severity of graft-versus-host reaction in bone marrow transplantation between HL-A-identical siblings. The disparity index may prove to be a useful means of predicting the severity of graft-versus-host reaction and the outcome of bone marrow graft when HL-A- and MLC-matched sibling donors are studied. The third-party MLC test is offered as a new method of histocompatibility testing. It may provide a useful model for the study of immunogenetics relative to so-called weaker histocompatibility determinants in man and experimental animals.
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Histocompatibility testing has been performed in the families of 20 patients with aplastic anemia or acute leukemia, in order to identify a compatible donor for marrow transplantation. In several cases, the interpretation of the tests has been difficult because of abnormalities in the immune reactivity of patients' lymphocytes. Humoral or cellular immunization against donor incompatible antigens seems to prevent a "take" of the graft or a subsequent hematological remission.
Histocompatibility testing prior to kidney transplantation is an established necessity. Recipient sensitization to HLA specificities affects the efficacy of the lymphocytotoxic cross-match and influences the achievable HLA mismatch. Within Europe most cadaver donor kidneys are allocated on the basis of minimum histocompatibility mismatch contrasting with the North American system which allows for exchange of kidneys only where there is no detectable donor/recipient mismatch. There is also a contrast between the immunosuppression protocols used in these continents with, in general, more aggressive regimens used in North America. In the 1990s there has been considerable refinement in the techniques available to histocompatibility laboratories for definition of HLA phenotypes and genotypes and some obstacles to successful transplantation have been overcome. We review some of these changes with particular reference to our own experience.
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Clinical histocompatibility testing has now developed to a stage where it is possible to select related bone marrow donors for some patients, when HLA genotypically identical siblings are not available. The most common type of such donors are the HLA phenotypically or HLA-D phenotypically identical related donors. The HLA-D homozygous recipient offers special options, since these patients can potentially receive bone marrow transplants from any of the parents or from HLA-haploidentical siblings. The studies in SCID have demonstrated that HLA-D compatibility in spite of HLA-A or B incompatibilities can be tolerated and there is now accumulating evidence that even patients with aplastic anemia or acute leukemia can be successfully treated with such bone marrow grafts.
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The specific lymphocytotoxic activity of an anti DLA-A 9 serum was completely removed when absorbed with spleen dry acetone powder from a DLA-A 9 dog, but was not modified when absorbed with spleen powder from a non DLA-A 9 dog. A lymphocytotoxic serum specific for DLA-B 13 was produced in a dog injected with spleen dry acetone powder from a DLA-B 13 dog.