Brief report: HLA-mismatched renal transplantation without maintenance immunosuppression
Brief report: HLA-mismatched renal transplantation without maintenance immunosuppression
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DOI：
10.1056/nejmoa071074
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发表时间：
2008-01-24
影响因子：
158.5
通讯作者：
Sachs, David H.
中科院分区：
文献类型：
--
作者：
Kawai, Tatsuo;Cosimi, A. Benedict;Sachs, David H.
5例终末期肾病患者接受了HLA单倍型不匹配的亲属活体供者的骨髓和肾联合移植，采用非清髓性预处理方案。所有受者均出现一过性嵌合体和可逆性毛细血管渗漏综合征。1例发生不可逆的体液排斥反应。在其他4名受者中，有可能在移植后9至14个月停止所有免疫抑制治疗，并且肾功能自移植以来保持稳定2.0至5.3年。在体外试验中，来自这四个受者的T细胞显示出供体特异性无反应性，并且在免疫抑制治疗撤销后获得的同种异体移植物活检标本中，存在高水平的P3（FOXP3）信使RNA（mRNA），但不存在颗粒酶B mRNA。
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.