Improvement of cadaveric renal allograft survival by thoracic duct drainage: relation with T-lymphocyte subset modifications assessed by flow-cytometry.

Thoracic duct drainage (TDD) with reinfusion of cell-free lymph was performed in 118 prospective recipients within four months before transplantation. TDD was unsuccessful in 27 patients (A); it yielded 1-19 X 10(9) lymphocytes in 25 cases (B) and 20-185 X -10(9) in 66 cases (C). The incidence of acute rejection episodes and the requirement for early post-transplant dialysis were lower in C than in A. Six patients were studied for T-lymphocyte subsets, using monoclonal antibodies from OKT series and a monomorphic and HLA-DR (BL2) raised in our laboratory. During TDD peripheral blood lymphocyte (PBL) counts decreased and the percentage of BL2 cells increased. Simultaneously, typical small PBL were replaced by large less differentiated cells slightly labelled by OKT3, some of them bearing both OKT4 and OKT8 markers. The larger the depletion, the earlier the emergence of immature T-cells. In lymph fluid, lymphocyte counts decreased later than in blood, the proportion of T8+ cells lacking Fc receptors increased with time. Changes in B patients were less than in C. These results support the hypothesis that T-cell subset modifications represent the main immunological change accounting for better allograft prognosis.