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Guinan EC, Contreras-Ruiz L, Crisalli K, Rickert C, Rosales I, Makar R, Colvin R, Geissler EK, Sawitzki B, Harden P, Tang Q, Blancho G, Turka LA, Markmann JF. Donor antigen-specific regulatory T cell administration to recipients of live donor kidneys: A ONE Study consortium pilot trial. Am J Transplant 2023; 23:1872-1881. [PMID: 37422112 DOI: 10.1016/j.ajt.2023.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 07/10/2023]
Abstract
Regulatory T cells (Tregs) can inhibit cellular immunity in diverse experimental models and have entered early phase clinical trials in autoimmunity and transplantation to assess safety and efficacy. As part of the ONE Study consortium, we conducted a phase I-II clinical trial in which purified donor antigen reactive (dar)-Tregs (CD4+CD25+CD127lo) were administered to 3 patients, 7 to 11 days after live donor renal transplant. Recipients received a modified immunosuppression regimen, without induction therapy, consisting of maintenance tacrolimus, mycophenolate mofetil, and steroids. Steroids were weaned off over 14 weeks. No rejection was seen on any protocol biopsy. Therefore, all patients discontinued mycophenolate mofetil 11 to 13 months posttransplant, per protocol. An early for-cause biopsy in 1 patient, 5 days after dar-Treg infusion, revealed absence of rejection and accumulation of Tregs in the kidney allograft. All patients had Treg-containing lymphoid aggregates evident on protocol biopsies performed 8 months posttransplant. The patients are now all >6 years posttransplant on tacrolimus monotherapy with excellent graft function. None experienced rejection episodes. No serious adverse events were attributable to Treg administration. These results support a favorable safety profile of dar-Tregs administered early after renal transplant, suggest early biopsy might be an instructive research endpoint and provide preliminary evidence of potential immunomodulatory activity.
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Affiliation(s)
- Eva C Guinan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| | - Laura Contreras-Ruiz
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| | - Kerry Crisalli
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Charles Rickert
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Ivy Rosales
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Robert Makar
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Robert Colvin
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Edward K Geissler
- University Hospital Regensburg, Department of Surgery, Regensburg, Germany.
| | - Birgit Sawitzki
- Institute of Medical Immunology, Virchow - Klinikum, Berlin, Germany.
| | - Paul Harden
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Qizhi Tang
- Division of Transplantation, Department of Surgery, University of California, San Francisco, California, USA.
| | - Giles Blancho
- Centre of Research in Transplantation and Immunology, Nantes University, Nantes, France.
| | - Laurence A Turka
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - James F Markmann
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA.
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2
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Yamamoto T, Atthota S, Agarwal D, Crisalli K, MacConmara M, Nakamura T, Teo R, Dageforde LA, Kimura S, Elias N, Yeh H, Bozorgzadeh A, Kawai T, Markmann JF. Impact of Portable Normothermic Machine Perfusion for Liver Transplantation From Adult Deceased Donors. Ann Surg 2023; 278:e922-e929. [PMID: 37581260 DOI: 10.1097/sla.0000000000006032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To assess how liver allografts preserved using portable normothermic machine perfusion (NMP) compare against those that underwent ischemic cold storage (ICS) in the setting of donation after brain death (DBD) and donation after circulatory death (DCD) liver transplantation (LT). BACKGROUND Compared with conventional ICS, NMP may offer more homeostatic preservation, permit physiological assessment of organ function, and provide opportunities for graft improvement/modification. We report a single-center US experience of liver NMP. METHODS A single-center, retrospective analysis of collected data on 541 adult whole LTs from 469 DBD donors [NMP (n = 58) vs ICS (n = 411)] and 72 DCD donors [NMP (n = 52) vs ICS (n = 20)] between January 2016 and December 2022. RESULTS In DBD LT, male sex [odds ratio (95% CI): 1.83 (1.08-3.09)] and >10% macrosteatosis of the donor liver [1.85 (1.10-3.10)] were statistically significant independent risk factors of early allograft dysfunction (EAD). Donor age >40 years and cold ischemia time >7 hours were independent risk factors of reperfusion syndrome (RPS). One-year, 3-year, and 5-year incidences of ischemic cholangiopathy (IC) did not differ significantly in DBD cases between the NMP and ICS cohorts. In DCD LT, NMP was an independent protective factor against EAD [0.11 (0.03-0.46)] and RPS [0.04 (0.01-0.25)]. The incidence of IC in the DCD cases at 1-year and 3-year time points was significantly lower in the NMP cohort (1.9% compared with 20% in the ICS group). CONCLUSIONS Compared with conventional ICS, NMP can significantly reduce the incidence of EAD, RPS, and IC after DCD LT.
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Affiliation(s)
- Takayuki Yamamoto
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Srilakshmi Atthota
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Divyansh Agarwal
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Kerry Crisalli
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | | | - Tsukasa Nakamura
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Richard Teo
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Leigh Anne Dageforde
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Shoko Kimura
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Nahel Elias
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Heidi Yeh
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Adel Bozorgzadeh
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Tatsuo Kawai
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - James F Markmann
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
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3
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Germain MJ, Greco BA, Hodgins S, Chapagain B, Thadhani R, Wojciechowski D, Crisalli K, Nathanson BH, Chait Y. Assessing accuracy of estimated dry weight in dialysis patients post transplantation: the kidney knows best. J Nephrol 2021; 34:2093-2097. [PMID: 34031847 DOI: 10.1007/s40620-021-01029-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/16/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Estimated dry weight is used to guide fluid removal during outpatient hemodialysis sessions. Errors in estimated dry weight can result in intradialytic hypotension and interdialytic fluid overload. The goal of this study was to assess the accuracy of estimated dry weight by comparing it to the 2-week post-transplant weight in two cohorts of hemodialysis patients. METHODS This observational, multi-center, retrospective cohort study included maintenance hemodialysis patients who underwent kidney transplantation at two medical centers in Massachusetts. The relationship between estimated dry weight pre-transplant and weight at week 2 post-transplant in patients with good allograft function (serum creatinine ≤ 1.5 mg/dL) was analyzed. Estimated dry weight was considered accurate if it was within ± 2% of the week 2 post-transplant weight. RESULTS Fifty seven patients with good allograft function were identified: mean age 54 ± 14 years, 32 (58%) from deceased donors, 22 (38.6%) females. 38 were Caucasian (66.7%), 11 Hispanic (19.3%), 3 black (5.3%), and 5 others (8.8%). 2-week mean post transplantation serum creatinine was 1.2 ± 0.2 mg/dL. Mean (SD) estimated dry weight was 71.4 ± 15.9. Before transplantation, only 14 (24.6%) patients were within ± 2% of the 2-week post-transplant weight; 23 (40.3%) were above and 20 (35.1%) were below. CONCLUSIONS Our point of view, based on the assumption that the weight of patients with good allograft function at 2 weeks post-transplant approaches their accurate dry weight, is that a majority of maintenance hemodialysis patients (75.4%) are hypervolemic or hypovolemic prior to renal transplantation. This highlights the importance of finding novel tools to achieve euvolemia in patients undertaking dialysis. Timely feedback regarding achieved weight 2 weeks post-transplant to treating nephrologists and dialysis centers may be a starting point for assessing accuracy of dry weight.
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Affiliation(s)
- Michael J Germain
- Renal and Transplant Associates of New England, PC, Springfield, MA, 01107, USA.,Baystate Medical Center, Springfield, MA, 01199, USA
| | - Barbara A Greco
- Renal and Transplant Associates of New England, PC, Springfield, MA, 01107, USA.,Baystate Medical Center, Springfield, MA, 01199, USA
| | - Spencer Hodgins
- Kidney Care and Transplant Service of New England, Springfield, MA, 01104, USA
| | - Bikash Chapagain
- MidState Nephrology Associates, 85 Church St, Middletown, CT, 06457, USA
| | - Ravi Thadhani
- Massachusetts General Brigham, Boston, MA, 02199, USA
| | | | | | | | - Yossi Chait
- University of Massachusetts, Amherst, MA, 01106, USA. .,MIE Department, University of Massachusetts, 160 Governors Drive, Amherst, MA, 01003-2210, USA.
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4
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Sawitzki B, Harden PN, Reinke P, Moreau A, Hutchinson JA, Game DS, Tang Q, Guinan EC, Battaglia M, Burlingham WJ, Roberts ISD, Streitz M, Josien R, Böger CA, Scottà C, Markmann JF, Hester JL, Juerchott K, Braudeau C, James B, Contreras-Ruiz L, van der Net JB, Bergler T, Caldara R, Petchey W, Edinger M, Dupas N, Kapinsky M, Mutzbauer I, Otto NM, Öllinger R, Hernandez-Fuentes MP, Issa F, Ahrens N, Meyenberg C, Karitzky S, Kunzendorf U, Knechtle SJ, Grinyó J, Morris PJ, Brent L, Bushell A, Turka LA, Bluestone JA, Lechler RI, Schlitt HJ, Cuturi MC, Schlickeiser S, Friend PJ, Miloud T, Scheffold A, Secchi A, Crisalli K, Kang SM, Hilton R, Banas B, Blancho G, Volk HD, Lombardi G, Wood KJ, Geissler EK. Regulatory cell therapy in kidney transplantation (The ONE Study): a harmonised design and analysis of seven non-randomised, single-arm, phase 1/2A trials. Lancet 2020; 395:1627-1639. [PMID: 32446407 PMCID: PMC7613154 DOI: 10.1016/s0140-6736(20)30167-7] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Use of cell-based medicinal products (CBMPs) represents a state-of-the-art approach for reducing general immunosuppression in organ transplantation. We tested multiple regulatory CBMPs in kidney transplant trials to establish the safety of regulatory CBMPs when combined with reduced immunosuppressive treatment. METHODS The ONE Study consisted of seven investigator-led, single-arm trials done internationally at eight hospitals in France, Germany, Italy, the UK, and the USA (60 week follow-up). Included patients were living-donor kidney transplant recipients aged 18 years and older. The reference group trial (RGT) was a standard-of-care group given basiliximab, tapered steroids, mycophenolate mofetil, and tacrolimus. Six non-randomised phase 1/2A cell therapy group (CTG) trials were pooled and analysed, in which patients received one of six CBMPs containing regulatory T cells, dendritic cells, or macrophages; patient selection and immunosuppression mirrored the RGT, except basiliximab induction was substituted with CBMPs and mycophenolate mofetil tapering was allowed. None of the trials were randomised and none of the individuals involved were masked. The primary endpoint was biopsy-confirmed acute rejection (BCAR) within 60 weeks after transplantation; adverse event coding was centralised. The RTG and CTG trials are registered with ClinicalTrials.gov, NCT01656135, NCT02252055, NCT02085629, NCT02244801, NCT02371434, NCT02129881, and NCT02091232. FINDINGS The seven trials took place between Dec 11, 2012, and Nov 14, 2018. Of 782 patients assessed for eligibility, 130 (17%) patients were enrolled and 104 were treated and included in the analysis. The 66 patients who were treated in the RGT were 73% male and had a median age of 47 years. The 38 patients who were treated across six CTG trials were 71% male and had a median age of 45 years. Standard-of-care immunosuppression in the recipients in the RGT resulted in a 12% BCAR rate (expected range 3·2-18·0). The overall BCAR rate for the six parallel CTG trials was 16%. 15 (40%) patients given CBMPs were successfully weaned from mycophenolate mofetil and maintained on tacrolimus monotherapy. Combined adverse event data and BCAR episodes from all six CTG trials revealed no safety concerns when compared with the RGT. Fewer episodes of infections were registered in CTG trials versus the RGT. INTERPRETATION Regulatory cell therapy is achievable and safe in living-donor kidney transplant recipients, and is associated with fewer infectious complications, but similar rejection rates in the first year. Therefore, immune cell therapy is a potentially useful therapeutic approach in recipients of kidney transplant to minimise the burden of general immunosuppression. FUNDING The 7th EU Framework Programme.
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Affiliation(s)
- Birgit Sawitzki
- Institute of Medical Immunology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Paul N Harden
- Oxford Transplantation Centre, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Petra Reinke
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Aurélie Moreau
- Centre de Recherche en Transplantation et Immunologie, Nantes Université, Inserm, Nantes, France; Institute of Transplantation Urology Nephrology, Nantes, France
| | - James A Hutchinson
- Department of Surgery, University of Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - David S Game
- Guy's & St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Qizhi Tang
- Division of Transplantation, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Eva C Guinan
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston MA, USA
| | - Manuela Battaglia
- Diabetes Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | - William J Burlingham
- Division of Transplantation, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ian S D Roberts
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mathias Streitz
- Institute of Medical Immunology, Charité, Universitätsmedizin Berlin, Berlin, Germany; BIH Center for Regenerative Therapies, Charité and Berlin Institute of Health, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Régis Josien
- Centre de Recherche en Transplantation et Immunologie, Nantes Université, Inserm, Nantes, France; Institute of Transplantation Urology Nephrology, Nantes, France; Laboratoire d'Immunologie, Cimna, Centre Hospitalier Universitaire, Nantes, France
| | - Carsten A Böger
- Department of Nephrology, University of Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Cristiano Scottà
- MRC Centre for Transplantation, Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - James F Markmann
- Center for Transplantation Sciences, Mass General Hospital, Boston, MA, USA
| | - Joanna L Hester
- Transplantation Research and Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Karsten Juerchott
- BIH Center for Regenerative Therapies, Charité and Berlin Institute of Health, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Cecile Braudeau
- Centre de Recherche en Transplantation et Immunologie, Nantes Université, Inserm, Nantes, France; Institute of Transplantation Urology Nephrology, Nantes, France; Laboratoire d'Immunologie, Cimna, Centre Hospitalier Universitaire, Nantes, France
| | - Ben James
- Department of Surgery, University of Regensburg, University Hospital Regensburg, Regensburg, Germany; Division of Personalized Tumor Therapy, Fraunhofer Institute for Experimental Medicine and Toxicology, Regensburg, Germany
| | | | - Jeroen B van der Net
- Oxford Transplantation Centre, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Tobias Bergler
- Department of Nephrology, University of Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Rossana Caldara
- Transplant Medicine, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | - William Petchey
- Oxford Transplantation Centre, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Matthias Edinger
- Department of Internal Medicine III, University of Regensburg, University Hospital Regensburg, Regensburg, Germany; Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | - Nathalie Dupas
- Beckman Coulter Life Sciences, Immunotech, Marseille, France
| | | | - Ingrid Mutzbauer
- Department of Surgery, University of Regensburg, University Hospital Regensburg, Regensburg, Germany; Division of Personalized Tumor Therapy, Fraunhofer Institute for Experimental Medicine and Toxicology, Regensburg, Germany
| | - Natalie M Otto
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Charité Campus Mitte, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin, Germany
| | - Maria P Hernandez-Fuentes
- MRC Centre for Transplantation, Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Fadi Issa
- Transplantation Research and Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University of Regensburg, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Ulrich Kunzendorf
- Clinic for Nephrology and Hypertension, Christian Albrechts University, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Stuart J Knechtle
- Department of Surgery, Duke Transplant Center, Duke University Medical Center, Durham, NC, USA
| | - Josep Grinyó
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain
| | - Peter J Morris
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Leslie Brent
- St Mary's Hospital Transplant Unit, Paddington, London, UK
| | - Andrew Bushell
- Transplantation Research and Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Laurence A Turka
- Center for Transplantation Sciences, Mass General Hospital, Boston, MA, USA
| | - Jeffrey A Bluestone
- UCSF Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Robert I Lechler
- MRC Centre for Transplantation, Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Hans J Schlitt
- Department of Surgery, University of Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Maria C Cuturi
- Centre de Recherche en Transplantation et Immunologie, Nantes Université, Inserm, Nantes, France; Institute of Transplantation Urology Nephrology, Nantes, France
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charité, Universitätsmedizin Berlin, Berlin, Germany; BIH Center for Regenerative Therapies, Charité and Berlin Institute of Health, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Peter J Friend
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Tewfik Miloud
- Beckman Coulter Life Sciences, Immunotech, Marseille, France
| | - Alexander Scheffold
- Institute for Immunology, Christian Albrechts University, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Antonio Secchi
- Vita-Salute San Raffaele University Milan, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | - Kerry Crisalli
- Center for Transplantation Sciences, Mass General Hospital, Boston, MA, USA
| | - Sang-Mo Kang
- Division of Transplantation, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel Hilton
- Guy's & St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Bernhard Banas
- Department of Nephrology, University of Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Gilles Blancho
- Centre de Recherche en Transplantation et Immunologie, Nantes Université, Inserm, Nantes, France; Institute of Transplantation Urology Nephrology, Nantes, France
| | - Hans-Dieter Volk
- Institute of Medical Immunology, Charité, Universitätsmedizin Berlin, Berlin, Germany; BIH Center for Regenerative Therapies, Charité and Berlin Institute of Health, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Giovanna Lombardi
- MRC Centre for Transplantation, Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Kathryn J Wood
- Transplantation Research and Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Edward K Geissler
- Department of Surgery, University of Regensburg, University Hospital Regensburg, Regensburg, Germany; Division of Personalized Tumor Therapy, Fraunhofer Institute for Experimental Medicine and Toxicology, Regensburg, Germany; Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany.
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5
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Kawai T, Sachs DH, Sprangers B, Spitzer TR, Saidman SL, Zorn E, Tolkoff-Rubin N, Preffer F, Crisalli K, Gao B, Wong W, Morris H, LoCascio SA, Sayre P, Shonts B, Williams WW, Smith RN, Colvin RB, Sykes M, Cosimi AB. Long-term results in recipients of combined HLA-mismatched kidney and bone marrow transplantation without maintenance immunosuppression. Am J Transplant 2014; 14:1599-611. [PMID: 24903438 PMCID: PMC4228952 DOI: 10.1111/ajt.12731] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 01/25/2023]
Abstract
We report here the long-term results of HLA-mismatched kidney transplantation without maintenance immunosuppression (IS) in 10 subjects following combined kidney and bone marrow transplantation. All subjects were treated with nonmyeloablative conditioning and an 8- to 14-month course of calcineurin inhibitor with or without rituximab. All 10 subjects developed transient chimerism, and in seven of these, IS was successfully discontinued for 4 or more years. Currently, four subjects remain IS free for periods of 4.5-11.4 years, while three required reinstitution of IS after 5-8 years due to recurrence of original disease or chronic antibody-mediated rejection. Of the 10 renal allografts, three failed due to thrombotic microangiopathy or rejection. When compared with 21 immunologically similar living donor kidney recipients treated with conventional IS, the long-term IS-free survivors developed significantly fewer posttransplant complications. Although most recipients treated with none or two doses of rituximab developed donor-specific antibody (DSA), no DSA was detected in recipients treated with four doses of rituximab. Although further revisions of the current conditioning regimen are planned in order to improve consistency of the results, this study shows that long-term stable kidney allograft survival without maintenance IS can be achieved following transient mixed chimerism induction.
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Affiliation(s)
- T. Kawai
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA,Corresponding author: Tatsuo Kawai,
| | - D. H. Sachs
- Transplantation Biology Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - B. Sprangers
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - T. R. Spitzer
- Bone Marrow Transplant Unit, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - S. L. Saidman
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - E. Zorn
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - N. Tolkoff-Rubin
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - F. Preffer
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - K. Crisalli
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - B. Gao
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - W. Wong
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - H. Morris
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - S. A. LoCascio
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - P. Sayre
- Immune Tolerance Network, San Francisco, CA
| | - B. Shonts
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - W. W. Williams
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - R.-N. Smith
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - R. B. Colvin
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - M. Sykes
- Columbia Center for Translational Immunology, Columbia University, New York, NY
| | - A. B. Cosimi
- Transplant Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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