Anticipation of renal transplant failure by postanastomosis biopsy and immunofluorescence.

Ninety-six pre- and postanastomosis allograft biopsies from 48 transplant recipients were studied employing the direct fluorescent antibody procedure. Of the 48 transplants studied, 26 postanastomosis biopsies showed significant blood vessel wall deposits consisting predominantly of 2-4+ staining IgM and C3 deposits. The corresponding preanastomosis biopsies showed only patchy intimal surface staining. All but two of the grafts with positive biopsies had been preserved by the pulsatile perfusion method for various periods of time. Twenty-three of the twenty-six grafts with positive findings failed within 1 month while only 2 of the 19 negative postanastomosis biopsies failed within the 1-month period. Based on these findings actual graft failure occurred in 89% of the patients with postanastomosis transplant biopsies with positive findings. Although crossmatch studies were negative in all cases, further immunologic studies of eluates obtained from positive postanastomosis biopsies revealed the presence of lymphocytotoxic IgM antibodies in three of five cases studied. These findings suggest that rapid deposition of undetected preformed lymphocytotoxic antibodies accumulate in the vessel walls following anastomosis and contribute to transplant failure.