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The IgG response to tetanus toxoid (TT) immunization was quantitated by by radioimmunoassay in patients with membranous nephropathy (MN) and healthy controls. Variation in subclass (ELISA) and electrical charge (isoelectric focussing, immunofixation & autoradiography) of the IgG response were also assessed. Total IgG and igG subclass responses were impaired in MN compared to controls, although this was only significant for IgG-3 (P less than 0 X 05). Non responders to TT were more common in MN, and response was independent of disease activity. No distinctive pattern of IgG subclass response or IgG spectrotype was seen in MN. Impaired response to TT was associated with HLA-DR3 among controls, and in MN (88 X 8% of whom were DR3) markedly depressed responses occurred in apparent DR3 homozygotes.

A 62 year old man with no relevant previous history presented with a nephrotic syndrome. Renal biopsy showed a membranous glomerulopathy and coincident investigation showed high serum titres of rheumatoid factors. It was not until some months later that he developed articular and extra-articular manifestations of rheumatoid arthritis.

1. In more than 1,100 kidney transplants performed at a single center in 21 years a conservative approach to immunosuppressive therapy and HLA antigen matching has ensured high survival rates after both short- and long-term follow-up. 2. Retransplantation has been carried out in 16.6% of patients with transplant survival rates not differing significantly from those in first transplant recipients. 3. Living-related donor transplants accounted for only 7.9% of cases since 1982 and transplant survival was no different from HLA-A,B,DR-identical cadaver donor transplants. 4. Pretransplant blood transfusions were given to over 98% of recipients since 1982 and transplant survival in such CsA-treated patients was 10% higher than in the few nontransfused recipients. 5. By adopting a meticulous policy of pretransplant cytotoxic antibody screening and HLA antibody definition followed by careful pretransplant crossmatching using all available patient sera, accelerated transplant rejection has largely been avoided. 6. Monitoring of posttransplant recipient sera has shown that the appearance of cytotoxic antibodies leads to transplant failure and these antibodies are usually directed against HLA antigens mismatched between donor and recipient. 7. Matching for HLA antigens has a striking positive effect on transplant survival with more than 30% difference between the no mismatch and no match groups. Positive HLA matching effects on transplant survival were found in retransplants, highly sensitized recipients, male and female recipients, all ABO blood groups, and after long-term (20 years) follow-up.