Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor-A multicenter analysis

Article Article scientifique Article Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor-A multicenter analysis eng 2018-07-13 2019-02 author Eder Michael 0000-0002-6341-1275 author Schwarz Christophe 0000-0002-7676-2779 743699 author Kammer Michael 0000-0003-4821-9928 author Jacobsen Niels author Masouridi Levrat Stavroula 844685 author Cowan Morton J author Chongkrairatanakul Tepsiri author Gaston Robert author Ravanan Rommel author Ishida Hideki author Bachmann Anette author Perez Alvarez Sergio 708766 author Koch Martina 0000-0001-8151-422X author Garrouste Cyril author Duffner Ulrich A author Cullis Brett 0000-0001-8909-686X author Schaap Nicolaas author Medinger Michael author Sørensen Søren Schwartz author Dauber Eva-Maria author Böhmig Georg author Regele Heinz author Berlakovich Gabriela A author Wekerle Thomas author Oberbauer Rainer 475-487 10.1111/ajt.14970 29900661 1600-6135 PMC6585795 <p>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.</p> Bone marrow/hematopoietic stem cell transplantation Clinical research/practice Kidney (allograft) function/dysfunction Kidney transplantation/nephrology Tolerance: clinical 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 / mortality Kidney Failure, Chronic / therapy Kidney Transplantation / mortality Living Donors / supply & distribution Male Middle Aged Prognosis Risk Factors Survival Rate Transplantation, Homologous Young Adult Dewey 616 56 Département de médecine 221 false 1216 Leucémie et transplantation allogénique de cellules souches hématopoïétiques 982 American journal of transplantation 19 2 ec82302f-16b3-41b5-9c82-9b88e1aa1457 Article (Published version) Public Article-scientifique-from-europePmc.pdf 880412 application/pdf CC BY-NC-ND openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor-A multicenter analysis	American journal of transplantation			2019	153	87

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Schwarz, Christophe