Brief report: HLA-mismatched renal transplantation without maintenance immunosuppression

被引：796

作者：

Kawai, Tatsuo ^{[1
,5
]}

Cosimi, A. Benedict ^{[1
,5
]}

Spitzer, Thomas R. ^{[3
,5
]}

Tolkoff-Rubin, Nina ^{[1
,5
]}

Suthanthiran, Manikkam ^{[6
]}

Saidman, Susan L. ^{[4
,5
]}

Shaffer, Juanita ^{[2
,5
]}

Preffer, Frederic I. ^{[4
,5
]}

Ding, Ruchuang ^{[6
]}

Sharma, Vijay ^{[6
]}

Fishman, Jay A. ^{[1
,5
]}

Dey, Bimalangshu ^{[3
,5
]}

Ko, Dicken S. C. ^{[1
,5
]}

Hertl, Martin ^{[1
,5
]}

Goes, Nelson B. ^{[1
,5
]}

Wong, Waichi ^{[1
,5
]}

Williams, Winfred W., Jr. ^{[1
,5
]}

Colvin, Robert B. ^{[4
,5
]}

Sykes, Megan ^{[2
,5
]}

Sachs, David H. ^{[2
,5
]}

机构：

[1] Massachusetts Gen Hosp, Transplantat Unit, Boston, MA 02114 USA

[2] Massachusetts Gen Hosp, Transplantat Biol Res Ctr, Boston, MA 02114 USA

[3] Massachusetts Gen Hosp, Dept Med, Bone Marrow Transplantat Program, Boston, MA 02114 USA

[4] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02114 USA

[5] Harvard Univ, Sch Med, Boston, MA USA

[6] New York Presbyterian Hosp Weill Cornell Med Ctr, Dept Med & Transplant Med, Div Nephrol, New York, NY USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2008年 / 358卷 / 04期

关键词：

D O I：

10.1056/NEJMoa071074

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Five patients with end-stage renal disease received combined bone marrow and kidney transplants from HLA single-haplotype mismatched living related donors, with the use of a nonmyeloablative preparative regimen. Transient chimerism and reversible capillary leak syndrome developed in all recipients. Irreversible humoral rejection occurred in one patient. In the other four recipients, it was possible to discontinue all immunosuppressive therapy 9 to 14 months after the transplantation, and renal function has remained stable for 2.0 to 5.3 years since transplantation. The T cells from these four recipients, tested in vitro, showed donor-specific unresponsiveness and in specimens from allograft biopsies, obtained after withdrawal of immunosuppressive therapy, there were high levels of P3 (FOXP3) messenger RNA (mRNA) but not granzyme B mRNA.

引用

页码：353 / 361

页数：9

共 28 条

[1] LONG-TERM RESULTS OF A CONTROLLED PROSPECTIVE-STUDY WITH TRANSFUSION OF DONOR-SPECIFIC BONE-MARROW IN 57 CADAVERIC RENAL-ALLOGRAFT RECIPIENTS [J].

BARBER, WH ;

MANKIN, JA ;

LASKOW, DA ;

DEIERHOI, MH ;

JULIAN, BA ;

CURTIS, JJ ;

DIETHELM, AG .

TRANSPLANTATION, 1991, 51 (01) :70-75

[2] Induction of kidney allograft tolerance after transient lymphohematopoietic chimerism in patients with multiple myeloma and end-stage renal disease [J].

Bühler, LH ;

Spitzer, TR ;

Sykes, M ;

Sachs, DH ;

Delmonico, FL ;

Tolkoff-Rubin, N ;

Saidman, SL ;

Sackstein, R ;

McAfee, S ;

Dey, B ;

Colby, C ;

Cosimi, AB .

TRANSPLANTATION, 2002, 74 (10) :1405-1409

[3] Effect of living-related donor bone marrow infusion on chimerism and in vitro immunoregulatory activity in kidney transplant recipients [J].

Ciancio, G ;

Burke, GW ;

Garcia-Morales, R ;

Suzart, K ;

Rosen, A ;

Ricordi, C ;

Kenyon, NS ;

Mathew, JM ;

Tzakis, AG ;

Esquenazi, V ;

Miller, J .

TRANSPLANTATION, 2002, 74 (04) :488-496

[4] Simultaneous administration of adjuvant donor bone marrow in pancreas transplant recipients [J].

Corry, RJ ;

Chakrabarti, PK ;

Shapiro, R ;

Rao, AS ;

Dvorchik, I ;

Jordan, ML ;

Scantlebury, VP ;

Vivas, CA ;

Fung, JJ ;

Starzl, TE .

ANNALS OF SURGERY, 1999, 230 (03) :372-379

[5] Mixed chimerism and tolerance without whole body irradiation in a large animal model [J].

Fuchimoto, Y ;

Huang, CA ;

Yamada, K ;

Shimizu, A ;

Kitamura, H ;

Colvin, RB ;

Ferrara, V ;

Murphy, MC ;

Sykes, M ;

White-Scharf, M ;

Neville, DM ;

Sachs, DH .

JOURNAL OF CLINICAL INVESTIGATION, 2000, 105 (12) :1779-1789

[6] Myeloma responses and tolerance following combined kidney and nonmyeloablative marrow transplantation:: In vivo and in vitro analyses [J].

Fudaba, Y. ;

Spitzer, T. R. ;

Shaffer, J. ;

Kawai, T. ;

Fehr, T. ;

Delmonico, F. ;

Preffer, F. ;

Tolkoff-Rubin, N. ;

Dey, B. R. ;

Saidman, S. L. ;

Kraus, A. ;

Bonnefoix, T. ;

McAfee, S. ;

Power, K. ;

Kattleman, K. ;

Colvin, R. B. ;

Sachs, D. H. ;

Cosimi, A. B. ;

Sykes, M. .

AMERICAN JOURNAL OF TRANSPLANTATION, 2006, 6 (09) :2121-2133

[7] C4d and C3d staining in biopsies of ABO- and HLA-incompatible renal allografts: Correlation with histologic findings [J].

Haas, M. ;

Rahman, M. H. ;

Racusen, L. C. ;

Kraus, E. S. ;

Bagnasco, S. M. ;

Segev, D. L. ;

Simpkins, C. E. ;

Warren, D. S. ;

King, K. E. ;

Zachary, A. A. ;

Montgomery, R. A. .

AMERICAN JOURNAL OF TRANSPLANTATION, 2006, 6 (08) :1829-1840

[8] Control of regulatory T cell development by the transcription factor Foxp3 [J].

Hori, S ;

Nomura, T ;

Sakaguchi, S .

SCIENCE, 2003, 299 (5609) :1057-1061

[9] Long-term outcome and alloantibody production in a non-myeloablative regimen for induction of renal allograft tolerance [J].

Kawai, T ;

Poncelet, A ;

Sachs, DH ;

Mauiyyedi, S ;

Boskovic, S ;

Wee, SL ;

Ko, DSC ;

Bartholomew, A ;

Kimikawa, M ;

Hong, HZ ;

Abrahamian, G ;

Colvin, RB ;

Cosimi, AB .

TRANSPLANTATION, 1999, 68 (11) :1767-1775

[10] CD154 blockade for induction of mixed chimerism and prolonged renal allograft survival in nonhuman primates [J].

Kawai, T ;

Sogawa, H ;

Boskovic, S ;

Abrahamian, G ;

Smith, RN ;

Wee, SL ;

Andrews, D ;

Nadazdin, O ;

Koyama, I ;

Sykes, M ;

Winn, HJ ;

Colvin, RB ;

Sachs, DH ;

Cosimi, AB .

AMERICAN JOURNAL OF TRANSPLANTATION, 2004, 4 (09) :1391-1398

← 1 2 3 →