Tolerance and Chimerism after Renal and Hematopoietic-Cell Transplantation
John D. Scandling, M.D., Stephan Busque, M.D., Sussan Dejbakhsh-Jones, M.S., Claudia Benike, B.S., Maria T. Millan, M.D., Judith A. Shizuru, M.D., Ph.D., Richard T. Hoppe, M.D., Robert Lowsky, M.D., Edgar G. Engleman, M.D., and Samuel Strober, M.D.
We describe a recipient of combined kidney and hematopoietic-celltransplants from an HLA-matched donor. A post-transplantationconditioning regimen of total lymphoid irradiation and antithymocyteglobulin allowed engraftment of the donor's hematopoietic cells.The patient had persistent mixed chimerism, and the functionof the kidney allograft has been normal for more than 28 monthssince discontinuation of all immunosuppressive drugs. Adverseevents requiring hospitalization were limited to a 2-day episodeof fever with neutropenia. The patient has had neither rejectionepisodes nor clinical manifestations of graft-versus-host disease.
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From the Departments of Medicine (J.D.S., S.D.-J., J.A.S., R.L., S.S.), Surgery (S.B., M.T.M.), Pathology (C.B., E.G.E.), and Radiation Oncology (R.T.H.), Stanford University School of Medicine, Stanford, CA.
Address reprint requests to Dr. Strober at the Department of Medicine, Stanford University School of Medicine, Center for Clinical Science Research Bldg., Suite 2215, 269 W. Campus Dr., Stanford, CA 94305, or at sstrober{at}stanford.edu.
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