title: Discontinuation of immunosuppression for prevention of kidney graft rejection after receiving a bone marrow transplant from the same HLA identical sibling donor.
abstract: Induction of tolerance in solid organ transplant recipients has been a long sought goal so that patients will not need lifelong immunosuppression. In this case report we review a patient who received a kidney transplant from an HLA matched related sibling and developed acute leukemia as a consequence of her immunosuppression. The patient was then treated with an allogeneic bone marrow transplant from her kidney donor. After the bone marrow transplant, all immunosuppression therapy for graft rejection and graft versus host disease was stopped. Six months after the bone marrow transplant, the patient's kidney function had no deterioration as a consequence of stopping immunosuppression. This illustrated that a combined solid organ/bone marrow transplant can help to induce tolerance. In fact, the tolerance to the bone marrow transplant for prevention of graft versus host disease may have been accomplished by the prior kidney transplant.
authors.affiliation: The University of Texas--M. D. Anderson Cancer Center, Department of Blood and Marrow Transplantation, Division of Cancer Medicine, Houston, Texas 77030, USA. jgajewsk@mail.mdanderson.org
authors.forename: James L
authors.initials: JL
authors.lastname: Gajewski
authors.forename: Cindy
authors.initials: C
authors.lastname: Ippoliti
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
mesh_terms: D016026:Bone Marrow Transplantation / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007108:Immune Tolerance; D007165:Immunosuppression Therapy / Q000379:methods; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D008875:Middle Aged; D035781:Siblings
chemical_list: D006680:HLA Antigens