HLA-mismatched renal transplantation without maintenance immunosuppression.

Authors :: Kawai T
Cosimi AB
Spitzer TR
Tolkoff-Rubin N
Suthanthiran M
Saidman SL
Shaffer J
Preffer FI
Ding R
Sharma V
Fishman JA
Dey B
Ko DS
Hertl M
Goes NB
Wong W
Williams WW Jr
Colvin RB
Sykes M
Sachs DH
Source :: The New England journal of medicine [N Engl J Med] 2008 Jan 24; Vol. 358 (4), pp. 353-61.
Publication Year :: 2008
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.<br /> (Copyright 2008 Massachusetts Medical Society.)