NEJM, Vol 358,pp 353-361, 2008
HLA-mismatched renal transplantation without maintenance immunosuppression
Kawai T, et al
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.
