First Successful Kidney Transplantation After Hematopoeitic Stem Cell Transplantation in Malaysia

Tan, M.H.; Kamil, Wan Mohd Rasis Wan Ahmad; Cheng, Mei Chih; Yee, S.Y.; Wahab, M.Z. Abdul; Yahya, Rosnawati; Bavanandan, Sunita

doi:10.1016/j.transproceed.2021.11.020

Cited by 2 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The recipients required no immunosuppression except for low doses of steroids, and both had excellent renal function without GVHD. Based on those successes, 28 cases of KTX after HSCT from the same donor have been reported, including our case (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Ten of those were KTXs from HLA-mismatched donors.…”

Section: Discussionmentioning

confidence: 95%

“…Renal dysfunction is a major complication of HSCT, leading to substantial morbidity and mortality [1]. Several cases of kidney transplantation (KTX) for end-stage renal disease (ESRD) from the same donor who supplied stem cells for HSCT have been reported; in those cases, immunosuppressive drugs could eventually be discontinued after immune tolerance was induced [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Theoretically, the recipient's immune system recognizes the kidney allograft as its own tissue with the same human leukocyte antigen (HLA) profile, and the kidney allograft will not be rejected even without use of immunosuppressive agents.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of Mixed Lymphocyte Reaction Assay to Evaluate Immune Tolerance before Kidney Transplantation with an Immunosuppression-Free Protocol following Hematopoietic Stem Cell Transplantation from the Same Donor

Nonoyama¹,

Hotta²,

Iwahara³

et al. 2023

Nephron

View full text Add to dashboard Cite

Several cases of kidney transplantation after hematopoietic stem cell transplantation (HSCT) from the same donor for end-stage renal disease have been reported. In those cases, immunosuppressive drugs were discontinued since immune tolerance was supposed to be induced. Theoretically, the recipient’s immune system recognizes the kidney allograft as its own tissue with the same human leukocyte antigen (HLA) profile, and the kidney allograft will not be rejected, even without the use of immunosuppressive agents. However, almost all recipients receive immunosuppressants in the early stages after kidney transplantation owing to concerns of acute rejection. Here, we report a successful case of post-HSCT kidney transplantation without the use of immunosuppressive drugs, in which a mixed lymphocyte reaction (MLR) assay was used to evaluate immune tolerance before kidney transplantation. The patient was a 25-year-old woman. Five years prior, she developed acute myeloid leukemia and underwent HLA-half-matched peripheral blood stem cell transplantation. Thereafter, she was in remission of the acute myeloid leukemia, but 1 year later, she developed renal graft-versus-host disease. Subsequently, the patient’s renal function gradually deteriorated to end-stage renal failure, and she underwent kidney transplantation with the previous stem cell donor: her mother. HLA typing of donor and recipient showed a complete chimerism in the peripheral blood. The pretransplantation complement-dependent cytotoxic crossmatch and flow cytometric T-cell crossmatch results were both negative, and HLA antibody measurements were all negative. The MLR assay revealed no T-lymphocyte reaction to the donor; therefore, immunosuppressants were not used. Two years after transplantation, the patient’s serum creatinine concentration was around 0.8 mg/dL (down from 4 mg/dL before transplantation). No abnormalities were observed in a renal biopsy performed after 3 months. Our study, along with others, indicates that immune tolerance to a donor develops in post-HSCT kidney transplantation from the same donor.

show abstract