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Two cadaver kidneys were preserved by the perfusion method with AB cryoprecipitated plasma which contained antidonor lymphocytotoxic antibody. The kidneys were transplanted subsequently and no demonstrable immunologic damage to the kidneys was observed in the preservation and post-transplantation periods. In one patient renal function was immediate, and function has remained satisfactory in the 3 month follow-up period. The other patient had an initial period (2 weeks) of acute tubular necrosis, but renal function became satisfactory and the patient's condition has remained stable in the 3 month follow-up period. The significance of antidonor lymphocytotoxic antibody in the plasma perfusate on subsequent kidney function has been discussed.

We measured prospectively changes in fractional protein clearance ratio (CPr/CCr) in 21 live-related (LR) and 41 cadaver donor (CD) renal transplants before and during onset of first rejections. Fifty-three recipients manifested a rejection within the first post-transplant month. Fractional protein clearance increased in all patients during rejection. An increase in CPr/CCr prior to other evidence of impending rejection, and therefore clinically useful, required at least a 10-day rejection-free interval dated from onset of diuresis (whether diuresis was immediate or delayed by acute tubular necrosis (ATN)). Twenty-three of 25 nonantilymphocyte globulin (ALG)-treated CD transplants manifested clinical and laboratory signs of the first rejection episode prior to the 10th day of diuresis compared with 5 of 21 LR and none of 16 ALG-treated CD transplants. Persistence of elevated CPr/CCr despite treatment forecast graft loss (11 of 13), whereas a decrease in this ratio was associated with ultimate reversal of the rejection process.