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J Thorac Cardiovasc Surg 1997;114:64-75
© 1997 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

PERINATAL INDUCTION OF IMMUNOTOLERANCE TO CARDIAC AND PULMONARY ALLOGRAFTS

Supported in part by the Ralph and Marian Falk Foundation for Cardiovascular Research. D.D.Y. is a recipient of an American Heart Association Postdoctoral Research Fellowship and National Institutes of Health Immunology Training Grant AI-07290.

Received for publication June 3, 1996 revisions requested July 15, 1996; revisions received Feb. 21, 1997 accepted for publication Feb. 25, 1997. Address for reprints: David D. Yuh, MD, Department of Surgery, Room H3680, Stanford University Medical Center, 300 Pasteur Dr., Stanford, CA 94305.

Abstract

Objectives: Tolerance appears to be more easily induced in the fetus before full immunocompetence is established, but elucidation of this process is needed. A model of perinatal tolerance induction to neonatal skin allografts followed by cardiac and pulmonary allografts is described. Methods: Sixty Lewis (RT1¹) rat fetuses were inoculated intraperitoneally at 18 days' gestation with 1 x 10⁷ ACI (RT1^a) rat fetal liver cells (group I); 20 Lewis fetuses were inoculated with 2 x 10⁷ ACI fetal liver cells (group II). Control groups consisted of Lewis fetuses inoculated with saline solution (n = 25, group III) and fetuses that were not inoculated (n = 25, group IV). Twenty-five of the 50 surviving group I rats received ACI skin (<24 hours old) and heart (8 to 10 weeks old) allografts (group IA); the remaining 25 rats received only ACI heart grafts (group IB). Groups II, III, and IV received ACI skin and cardiac allografts. Recipients tolerant to both skin and cardiac grafts received orthotopic ACI lung grafts and third-party skin grafts. Tolerance was indicated by graft survival for more than 100 days. Limiting dilution and flow cytometric analyses were performed.

Results: Abortion rates in groups I, II, III, and IV were 17% (10/60), 65% (13/20), 8% (2/25), and 4% (1/25), respectively. Specific tolerance to skin, cardiac, and lung allografts was observed in seven of 25 group IA recipients (28%) and seven of seven group II recipients (100%) compared with no tolerance in any group IB, III, or IV recipients (p = 0.03, ² test). A 100-fold reduction of precursor cytotoxic T lymphocytes and significant splenocyte and bone marrow chimerism in tolerant versus nontolerant rats were noted (p = 0.0001, Student's t test). Conclusions: Using donor-strain fetal liver cells and neonatal skin grafts, we achieved higher frequencies of tolerance to solid organ grafts in adulthood with lower cell inocula and abortion rates than previously described. Chimerism and depressed precursor cytotoxic T lymphocyte frequencies in tolerant recipients suggest that hematopoietic stem cell engraftment and clonal deletion/anergy are involved in induction of perinatal tolerance