Clinical Aspects and Immunosuppression

This chapter reviews the early history of allotransplantation. Sporadic attempts at transplanting human allogeneic kidneys were a failure, and the first success was kidneys transplanted from monozygotic twin donors. Such grafts do not involve the recipient's immune system, but their importance lies in demonstrating that transplanted kidneys could function and maintain the recipient in good health for many years, and they help to make the transplantation of allografts a suitable objective. The use of whole body irradiation (WBI), with or without the replacement of the host's bone marrow with allogeneic bone marrow cells from the donor, was a vital subject in the 1950s. Once it was accepted that the poor survival of allogeneic human kidneys was brought about by an immune response of the recipient, this form of treatment was attempted in kidney transplantation, mainly in Boston and Paris, toward the end of the 1950s. The strategy varied between giving sub-lethal doses of WBI or potentially lethal doses, followed by the infusion of donor bone marrow to replace that of the patient. Other attempts at manipulating WBI for the betterment of kidney allograft recipients were made both in the United States and in France.