In vitro monitoring of cadaver kidney donor pretreatment by lymphocyte culture.

Fourteen cadaver kidney donors were pretreated with a rapid infusion of 5 g of cyclophosphamide and 5 g of methylprednisolone in an attempt to reduce graft immunogenicity by altering immunogenic "passenger" leucocytes. The effects of this drug infusion on peripheral lymphocytes were monitored by measuring the ability of donor lymphocytes to respond and to stimulate recipient cells in mixed lymphocyte culture and by measuring their ability to respond to phytohaemagglutinin stimulation before and after infusion of the drugs. Pretreatment severely decreased the ability of donor cells to function in these tests, but the maximum effect was not seen until several hours after completion of the infusion. The results of this study suggest that donor nephrectomy should be delayed for at least 4 hr after pretreatment to obtain maximum lymphocyte effect using this regimen. This type of in vitro testing may provide means of monitoring donor pretreatment and comparing different pretreatment protocols in human cadaveric allotransplantation.