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Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor - A multicenter analysis

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Michael Eder
  • Christoph Schwarz
  • Michael Kammer
  • Niels Jacobsen
  • Masouridi Levrat Stavroula
  • Morton J Cowan
  • Tepsiri Chongkrairatanakul
  • Robert Gaston
  • Rommel Ravanan
  • Hideki Ishida
  • Anette Bachmann
  • Sergio Alvarez
  • Martina Koch
  • Cyril Garrouste
  • Ulrich A Duffner
  • Brett Cullis
  • Nicolaas Schaap
  • Michael Medinger
  • Eva-Maria Dauber
  • Georg Böhmig
  • Heinz Regele
  • Gabriela A Berlakovich
  • Thomas Wekerle
  • Rainer Oberbauer

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.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Transplantation
Vol/bind19
Udgave nummer2
Sider (fra-til)475-487
Antal sider13
ISSN1600-6135
DOI
StatusUdgivet - 2019

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