Tolerance and Chimerism after Renal and Hematopoietic-Cell Transplantation

• Published in: The New England journal of medicine Vol. 358; no. 4; pp. 362 - 368
• Main Authors: Scandling, John D, Busque, Stephan, Dejbakhsh-Jones, Sussan, Benike, Claudia, Millan, Maria T, Shizuru, Judith A, Hoppe, Richard T, Lowsky, Robert, Engleman, Edgar G, Strober, Samuel
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 24.01.2008
• Subjects: Biological and medical sciences; Combined Modality Therapy; General aspects; Hematopoietic Stem Cell Transplantation; Histocompatibility Testing; Humans; Kidney Failure, Chronic - surgery; Kidney Transplantation - immunology; Lymphocyte Count; Male; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; T-Lymphocytes - immunology; Transplantation Chimera - immunology; Transplantation Conditioning; Transplantation Immunology; Transplantation Tolerance - immunology; Transplantation, Homologous; Medicine; Surgery; Stem cell; Hematopoietic cell; Tolerance; Graft; Chimerism; Kidney transplantation
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa074191

A patient received a kidney graft from his HLA-identical brother, followed by an infusion of CD34+ hematopoietic stem cells from the same donor. An apparent state of immunologic tolerance to the kidney allograft developed, allowing withdrawal of all immunosuppressive therapy within 6 months. A patient received a kidney graft from his HLA-identical brother, followed by an infusion of CD34+ hematopoietic stem cells from the same donor. Immunologic tolerance to the kidney allograft developed, allowing withdrawal of all immunosuppressive therapy within 6 months. Immune tolerance of organ transplants has been induced in laboratory animals when persistent mixed blood and immune-cell chimerism has been achieved by infusing hematopoietic cells from the organ donor before or after transplantation of the organ. 1 – 3 The continued presence of the organ donor's immune cells in the recipient's thymus and peripheral lymphoid tissue promotes and maintains immune tolerance by eliminating T-cell clones that can react to alloantigens of the graft. 1 – 3 We have attempted to achieve persistent mixed chimerism and tolerance in humans after transplantation of combined HLA-matched kidney and hematopoietic cells, using a low-intensity conditioning regimen of total . . .