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Nonoyama S, Hotta K, Iwahara N, Tanabe T, Hirose T, Harada S, Junichi S, Nakazawa D, Shigematsu A, Otsuka T, Shinohara N. Use of Mixed Lymphocyte Reaction Assay to Evaluate Immune Tolerance before Kidney Transplantation with an Immunosuppression-Free Protocol following Hematopoietic Stem Cell Transplantation from the Same Donor. Nephron Clin Pract 2023; 147:621-626. [PMID: 37231903 DOI: 10.1159/000531031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023] Open
Abstract
Several cases of kidney transplantation after hematopoietic stem cell transplantation (HSCT) from the same donor for end-stage renal disease have been reported. In those cases, immunosuppressive drugs were discontinued since immune tolerance was supposed to be induced. Theoretically, the recipient's immune system recognizes the kidney allograft as its own tissue with the same human leukocyte antigen (HLA) profile, and the kidney allograft will not be rejected, even without the use of immunosuppressive agents. However, almost all recipients receive immunosuppressants in the early stages after kidney transplantation owing to concerns of acute rejection. Here, we report a successful case of post-HSCT kidney transplantation without the use of immunosuppressive drugs, in which a mixed lymphocyte reaction (MLR) assay was used to evaluate immune tolerance before kidney transplantation. The patient was a 25-year-old woman. Five years prior, she developed acute myeloid leukemia and underwent HLA-half-matched peripheral blood stem cell transplantation. Thereafter, she was in remission of the acute myeloid leukemia, but 1 year later, she developed renal graft-versus-host disease. Subsequently, the patient's renal function gradually deteriorated to end-stage renal failure, and she underwent kidney transplantation with the previous stem cell donor: her mother. HLA typing of donor and recipient showed a complete chimerism in the peripheral blood. The pretransplantation complement-dependent cytotoxic crossmatch and flow cytometric T-cell crossmatch results were both negative, and HLA antibody measurements were all negative. The MLR assay revealed no T-lymphocyte reaction to the donor; therefore, immunosuppressants were not used. Two years after transplantation, the patient's serum creatinine concentration was around 0.8 mg/dL (down from 4 mg/dL before transplantation). No abnormalities were observed in a renal biopsy performed after 3 months. Our study, along with others, indicates that immune tolerance to a donor develops in post-HSCT kidney transplantation from the same donor.
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Affiliation(s)
- Sho Nonoyama
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Naoya Iwahara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Takayuki Hirose
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Shigeru Harada
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Sugita Junichi
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Daigo Nakazawa
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Akio Shigematsu
- Department of Hematology, Kushiro Rosai Hospital, Kushiro, Japan
| | - Takuya Otsuka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Eder M, Schwarz C, Kammer M, Jacobsen N, Stavroula ML, Cowan MJ, Chongkrairatanakul T, Gaston R, Ravanan R, Ishida H, Bachmann A, Alvarez S, Koch M, Garrouste C, Duffner UA, Cullis B, Schaap N, Medinger M, Sørensen SS, Dauber E, Böhmig G, Regele H, Berlakovich GA, Wekerle T, Oberbauer R. Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor-A multicenter analysis. Am J Transplant 2019; 19:475-487. [PMID: 29900661 PMCID: PMC6585795 DOI: 10.1111/ajt.14970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 01/25/2023]
Abstract
Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 μmol/l (interquartile range [IQR] 72-99) in the tolerant cohort and 118 μmol/l (IQR 99-143) in the control group. Mixed linear-model showed around 29% lower average creatinine levels throughout follow-up in the tolerant group (P < .01). Our data clearly show stable renal graft function without long-term immunosuppression for many years, suggesting permanent donor-specific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients.
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Affiliation(s)
- Michael Eder
- Department of Internal Medicine IIIDivision of Nephrology and DialysisMedical University of ViennaViennaAustria
| | - Christoph Schwarz
- Department of SurgeryDivision of TransplantationMedical University ViennaViennaAustria
| | - Michael Kammer
- Department of Internal Medicine IIIDivision of Nephrology and DialysisMedical University of ViennaViennaAustria,Center for Medical StatisticsInformatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Niels Jacobsen
- Department of HaematologyFinsen CentreNational University Hospital, RigshospitaletCopenhagenDenmark
| | | | - Morton J. Cowan
- Pediatric Allergy Immunology and Blood and Marrow Transplant DivisionUniversity of California San FranciscoBenioff Children's HospitalSan FranciscoCAUSA
| | | | - Robert Gaston
- Department of MedicineDivision of NephrologyUniversity of Alabama at BirminghamBirminghamALUSA
| | | | - Hideki Ishida
- Department of UrologyTokyo Woman′s Medical UniversityTokyoJapan
| | - Anette Bachmann
- Department of Internal Medicine, Neurology and DermatologyDivision of NephrologyUniversity Hospital LeipzigLeipzigGermany
| | | | - Martina Koch
- Department of Hepatobiliary and Transplantation SurgeryUniversity Hospital Hamburg‐EppendorfHamburgGermany
| | - Cyril Garrouste
- Department of NephrologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Ulrich A. Duffner
- Helen DeVos Children's HospitalBlood and Bone Marrow Transplant ProgramGrand RapidsMIUSA
| | - Brett Cullis
- Renal UnitGreys HospitalPietermaritzburgSouth Africa
| | - Nicolaas Schaap
- Department of HematologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Michael Medinger
- Division of Hematology and Internal MedicineDepartment of MedicineUniversity Hospital BaselBaselSwitzerland
| | | | - Eva‐Maria Dauber
- Department of Blood Group Serology and Transfusion MedicineMedical University of ViennaViennaAustria
| | - Georg Böhmig
- Department of Internal Medicine IIIDivision of Nephrology and DialysisMedical University of ViennaViennaAustria
| | - Heinz Regele
- Clinical Institute of PathologyMedical University of ViennaViennaAustria
| | | | - Thomas Wekerle
- Section of Transplantation ImmunologyDepartment of SurgeryMedical University of ViennaViennaAustria
| | - Rainer Oberbauer
- Department of Internal Medicine IIIDivision of Nephrology and DialysisMedical University of ViennaViennaAustria
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