title: Kidney transplantation after liver transplantation from the same donor: four cases of successful steroid withdrawal.
abstract: BACKGROUND
  Administration of corticosteroids to kidney recipients has hampered the complete clinical success of kidney transplantation. Because most organ transplantation in Japan is living-related, we had the experience of performing kidney transplantation (KT) after liver transplantation (LT) from the same donor in four patients and successfully withdrew corticosteroid administration.
  
  
  METHODS
  Three pediatric and one adult patient received kidney allografts from 3 to 10 months after LT from the same donor. The immunosuppressive regimen consisted of a corticosteroid and tacrolimus. The steroid was withdrawn after KT in all four patients. After complete withdrawal of the steroid, DNA was extracted from two recipients and examined by polymerase chain reaction to detect microchimerism. A mixed lymphocyte reaction (MLR) and cell-mediated lymphocytotoxicity assay (CML) were performed to test for donor-specific hyporesponsiveness.
  
  
  RESULTS
  Steroid withdrawal was successfully accomplished after KT in every patient. No steroid-withdrawal-associated complications were observed. In the three pediatric patients, remarkable catch-up growth was observed after steroid withdrawal. In the two patients tested, donor DNA was not detected by polymerase chain reaction, suggesting the absence of microchimerism. MLR and CML showed that recipient lymphocytes reacted against donor lymphocytes at the same level as against the third-party lymphocytes.
  
  
  CONCLUSIONS
  Steroid withdrawal was successfully achieved in four kidney recipients who had received a liver allograft from the same donor. The MLR and CML findings indicated the absence of donor-specific hyporesponsiveness in vitro. Although the precise mechanism is not yet clear, KT after LT from the same donor should be considered as a method that allows steroids to be withdrawn from the immunosuppressive regimen of KT.
authors.affiliation: Department of Surgery, Kidney Center, Tokyo Women's Medical University, 8-1 Kawata-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Fuchinoue
authors.forename: Tokihiko
authors.initials: T
authors.lastname: Sawada
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuji
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kai
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Tojimbara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakajima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shiraga
authors.forename: Katsumi
authors.initials: K
authors.lastname: Ito
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teraoka
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001663:Bilirubin / Q000097:blood; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D003602:Cytotoxicity, Immunologic; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D016031:Liver Transplantation / Q000276:immunology / Q000473:pathology / Q000502:physiology*; D019520:Living Donors; D007959:Lymphocyte Culture Test, Mixed; D008297:Male; D009679:Nuclear Family; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology; D016559:Tacrolimus / Q000627:therapeutic use; D018183:Transplantation Chimera
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003404:Creatinine; D001663:Bilirubin; D016559:Tacrolimus