Progress in clinical renal transplantation

From the practical or clinical side, it is worth concluding with strong statements. Recipient serum screening for antibody and a negative donor-recipient crossmatch (T cell) is essential for success in cadaver donor transplantation; HLA-A, B, and C compatibility is not. Family genotyping and the identification of HLA-identical and mixed lymphocyte culture (MLC) nonreactive sibling donors allows the selection of transplants that behave differently than all others, indicating the importance of the HLA locus. Preservation provides opportunities for technical errors, and it must be done right. Blood transfusions need not be withheld from symptomatically anemic potential recipients. DNCB skin testing separates responders from nonresponders. Recall antigen testing distinguishes a group of anergic patients who have a high mortality. ATG works in man if potent, used in sufficient quantity, and in sufficient duration. Equilibrium immunoregulation maintained by strong negative feedback loops in the immune response best explains graft success; its engineering is the goal of the future.