Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor-A multicenter analysis
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID 4499904
Author(s) Eder, Michael; Schwarz, Christoph; Kammer, Michael; Jacobsen, Niels; Stavroula, Masouridi Levrat; Cowan, Morton J.; Chongkrairatanakul, Tepsiri; Gaston, Robert; Ravanan, Rommel; Ishida, Hideki; Bachmann, Anette; Alvarez, Sergio; Koch, Martina; Garrouste, Cyril; Duffner, Ulrich A.; Cullis, Brett; Schaap, Nicolaas; Medinger, Michael; Sørensen, Søren Schwartz; Dauber, Eva-Maria; Böhmig, Georg; Regele, Heinz; Berlakovich, Gabriela A.; Wekerle, Thomas; Oberbauer, Rainer
Author(s) at UniBasel Medinger, Michael
Year 2019
Title Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor-A multicenter analysis
Journal American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Volume 19
Number 2
Pages / Article-Number 475-487
Mesh terms Adolescent; Adult; Allografts; Case-Control Studies; Combined Modality Therapy; Female; Follow-Up Studies; Graft Survival; Hematopoietic Stem Cell Transplantation, mortality; Humans; Immunosuppressive Agents, therapeutic use; Kidney Failure, Chronic, therapy; Kidney Transplantation, mortality; Living Donors, supply & distribution; Male; Middle Aged; Prognosis; Risk Factors; Survival Rate; Transplantation, Homologous; Young Adult
Abstract 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.
Publisher WILEY
ISSN/ISBN 1600-6143
Full Text on edoc No
Digital Object Identifier DOI 10.1111/ajt.14970
PubMed ID
ISI-Number WOS:000459726600021
Document type (ISI) Journal Article, Multicenter Study

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