title: Outcomes of renal transplantation following bone marrow transplantation.
abstract: This single center retrospective study was undertaken to determine the outcome of kidney transplantation (KT) after bone marrow transplantation (BMT) and also to determine the need for immunosuppressive therapy after KT when the BMT marrow donor is the KT donor. Kidney transplantation was performed in 10 patients with BMT nephropathy (BMTN). In six patients, the KT donor was the BMT donor; these individuals were given no long-term immunosuppression. Four other patients received KT from donors who were not the marrow donor (two living donors, two cadaveric donors). After median follow up of 34 months, no patient had an episode of acute rejection. All graft losses (n = 4) resulted from patient death. Three were because of infectious processes, including two infectious deaths in patients not on immunosuppression. Median estimated actuarial patient and graft survival (Kaplan-Meier) was 105 months. We conclude that patients with BMTN who receive KT from their marrow donor do not require immunosuppression. Whether immunosuppressive therapy is given or not, outcome appears to be determined largely by BMT-related immune dysfunction.
authors.affiliation: Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, USA. john-bertolatus@uiowa.edu
authors.forename: Khaled
authors.initials: K
authors.lastname: Hamawi
authors.forename: Margarida
authors.initials: M
authors.lastname: De Magalhaes-Silverman
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bertolatus
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning; D014181:Transplantation Immunology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents