Tolerance and Chimerism after Renal and Hematopoietic-Cell Transplantation

TLDR

We describe a recipient of combined kidney and hematopoietic‑cell transplants from an HLA‑matched donor. A post‑transplantation conditioning regimen of total lymphoid irradiation and antithymocyte globulin allowed engraftment of the donor's hematopoietic cells. The patient maintained persistent mixed chimerism and normal kidney allograft function for more than 28 months after discontinuing all immunosuppressive drugs, experienced only a brief 2‑day fever with neutropenia, and has had no rejection episodes or graft‑versus‑host disease.

Abstract

We describe a recipient of combined kidney and hematopoietic-cell transplants from an HLA-matched donor. A post-transplantation conditioning regimen of total lymphoid irradiation and antithymocyte globulin allowed engraftment of the donor's hematopoietic cells. The patient had persistent mixed chimerism, and the function of the kidney allograft has been normal for more than 28 months since discontinuation of all immunosuppressive drugs. Adverse events requiring hospitalization were limited to a 2-day episode of fever with neutropenia. The patient has had neither rejection episodes nor clinical manifestations of graft-versus-host disease.