Preliminary report: dramatic rise in renal allograft failure rate.

In 1989 the 1-year renal allograft survival at the Guy's Hospital paediatric transplant unit fell from 80% to 48%. The children were negative for HLA antibodies but 10 of the 21 were positive for an IgM antibody against epithelial cells (AEC). The 10 AEC-positive children had received a total of 12 grafts; 9 were lost and 3 were saved by means of plasma exchange. The 11 children without AEC received 11 grafts; 3 were lost, 2 owing to thrombosis. The correlation between the presence of AEC and graft rejection was highly significant. AEC have since been found in adult transplant recipients who suffered clinically similar graft failure, both at Guy's Hospital and at another hospital. The apparent spread of the antibody suggests an infective agent, but until the cause is identified kidney transplants in the paediatric unit have been suspended.