TY - JOUR
T1 - Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor-A multicenter analysis
AU - Eder, Michael
AU - Schwarz, Christoph
AU - Kammer, Michael
AU - Jacobsen, Niels
AU - Stavroula, Masouridi Levrat
AU - Cowan, Morton J
AU - Chongkrairatanakul, Tepsiri
AU - Gaston, Robert
AU - Ravanan, Rommel
AU - Ishida, Hideki
AU - Bachmann, Anette
AU - Alvarez, Sergio
AU - Koch, Martina
AU - Garrouste, Cyril
AU - Duffner, Ulrich A
AU - Cullis, Brett
AU - Schaap, Nicolaas
AU - Medinger, Michael
AU - Sørensen, Søren Schwartz
AU - Dauber, Eva-Maria
AU - Böhmig, Georg
AU - Regele, Heinz
AU - Berlakovich, Gabriela A
AU - Wekerle, Thomas
AU - Oberbauer, Rainer
N1 - © 2018 The Authors American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2019/2
Y1 - 2019/2
N2 - 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.
AB - 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.
KW - bone marrow/hematopoietic stem cell transplantation
KW - clinical research/practice
KW - kidney (allograft) function/dysfunction
KW - kidney transplantation/nephrology
KW - tolerance: clinical
U2 - 10.1111/ajt.14970
DO - 10.1111/ajt.14970
M3 - Journal article
C2 - 29900661
SN - 1600-6135
VL - 19
SP - 475
EP - 487
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 2
ER -