Perioperative donor bone marrow infusion augments chimerism in heart and lung transplant recipients.
BACKGROUND
We and others have demonstrated that a low level of donor cell chimerism was present for years after transplantation in tissues and peripheral blood of heart and lung recipients; it was associated, in the latter, with a lower incidence of chronic rejection. To augment this phenomenon, we initiated a trial combining simultaneous infusion of donor bone marrow with heart or lung allotransplantation.


METHODS
Between September 1993 and January 1995, 15 nonconditioned patients received either heart (n = 10) or lung (n = 5) allografts concurrently with an infusion of unmodified donor bone marrow (3.0 x 10(8) cells/kg), and were maintained on immunosuppressive regimen consisting of tacrolimus and steroids.


RESULTS
There was no complication associated with the infusion of donor bone marrow. Chimerism was detectable in 73% of bone marrow-augmented patients up to the last sample tested. Of the 5 control recipients who did not receive bone marrow infusion, only 1 had detectable chimerism by flow on postoperative day 15, which dwindled to an undetectable level by postoperative day 36. None of the patients had evidence of donor-specific immune modulation by mixed lymphocyte reaction.


CONCLUSIONS
The combined infusion of donor bone marrow and heart or lung transplantation, without preconditioning of the recipient, is safe and is associated with an augmentation of donor cell chimerism.
Pham
S M
SM
Pittsburgh Transplantation Institute, Pennsylvania.
Keenan
R J
RJ
Rao
A S
AS
Fontes
P A
PA
Kormos
R L
RL
Abu-Elmagd
K
K
Zeevi
A
A
Kawai
A
A
Hattler
B G
BG
Hardesty
R L
RL
D000328:Adult; D016026:Bone Marrow Transplantation / Q000502:physiology*; D016022:Case-Control Studies; D005434:Flow Cytometry; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D016040:Lung Transplantation / Q000502:physiology*; D007959:Lymphocyte Culture Test, Mixed; D008875:Middle Aged; D011446:Prospective Studies; D018183:Transplantation Chimera; D014184:Transplantation, Homologous; D016896:Treatment Outcome