HLA-Mismatched Renal Transplantation without Maintenance Immunosuppression

Tatsuo Kawai(Harvard University), A. Benedict Cosimi(Massachusetts General Hospital), Thomas R. Spitzer(Massachusetts General Hospital), Nina Tolkoff-Rubin(Massachusetts General Hospital), Manikkam Suthanthiran(NewYork–Presbyterian Hospital), Susan L. Saidman(Harvard University), Juanita Shaffer(Harvard University), Frederic I. Preffer(Harvard University), Ruchuang Ding(Cornell University), Vijay K. Sharma(New York Hospital Queens), Jay A. Fishman(Harvard University), Bimalangshu R. Dey(Massachusetts General Hospital), Dicken S.C. Ko(Massachusetts General Hospital), Martin Hertl(Harvard University), Nelson Goes(Massachusetts General Hospital), Waichi Wong(Harvard University), Winfred W. Williams, Robert B. Colvin(Massachusetts General Hospital), Megan Sykes(Massachusetts General Hospital), David H. Sachs(Harvard University)
New England Journal of Medicine
January 23, 2008
10.1056/nejmoa071074
Cited by 968Open Access
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Abstract

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.

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