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.
Source Information
From the Transplantation Unit (T.K., A.B.C., N.T.-R., J.A.F., D.S.C.K., M.H., N.B.G., W.W., W.W.W.), Transplantation Biology Research Center (J.S., M. Sykes, D.H.S.), Bone Marrow Transplantation Program, Department of Medicine (T.R.S., B.D.), and Department of Pathology (S.L.S., F.I.P., R.B.C.), Massachusetts General Hospital, and Harvard Medical School, Boston; and the Division of Nephrology, Department of Medicine and Transplant Medicine, New York Presbyterian Hospital–Weill Cornell Medical Center, New York (M. Suthanthiran, R.D., V.S.).
Address reprint requests to Dr. Sachs at Massachusetts General Hospital Transplantation Biology Research Center, 149 13th St., Charlestown, MA 02129.
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