title: HLA-mismatched renal transplantation without maintenance immunosuppression.
abstract: Five patients with end-stage renal disease received combined bone marrow and kidney transplants from HLA single-haplotype mismatched living related donors, with the use of a nonmyeloablative preparative regimen. Transient chimerism and reversible capillary leak syndrome developed in all recipients. Irreversible humoral rejection occurred in one patient. In the other four recipients, it was possible to discontinue all immunosuppressive therapy 9 to 14 months after the transplantation, and renal function has remained stable for 2.0 to 5.3 years since transplantation. The T cells from these four recipients, tested in vitro, showed donor-specific unresponsiveness and in specimens from allograft biopsies, obtained after withdrawal of immunosuppressive therapy, there were high levels of P3 (FOXP3) messenger RNA (mRNA) but not granzyme B mRNA.
authors.affiliation: Transplantation Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, USA.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kawai
authors.forename: A Benedict
authors.initials: AB
authors.lastname: Cosimi
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Spitzer
authors.forename: Nina
authors.initials: N
authors.lastname: Tolkoff-Rubin
authors.forename: Manikkam
authors.initials: M
authors.lastname: Suthanthiran
authors.forename: Susan L
authors.initials: SL
authors.lastname: Saidman
authors.forename: Juanita
authors.initials: J
authors.lastname: Shaffer
authors.forename: Frederic I
authors.initials: FI
authors.lastname: Preffer
authors.forename: Ruchuang
authors.initials: R
authors.lastname: Ding
authors.forename: Vijay
authors.initials: V
authors.lastname: Sharma
authors.forename: Jay A
authors.initials: JA
authors.lastname: Fishman
authors.forename: Bimalangshu
authors.initials: B
authors.lastname: Dey
authors.forename: Dicken S C
authors.initials: DS
authors.lastname: Ko
authors.forename: Martin
authors.initials: M
authors.lastname: Hertl
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Goes
authors.forename: Waichi
authors.initials: W
authors.lastname: Wong
authors.forename: Winfred W
authors.initials: WW
authors.lastname: Williams
authors.forename: Robert B
authors.initials: RB
authors.lastname: Colvin
authors.forename: Megan
authors.initials: M
authors.lastname: Sykes
authors.forename: David H
authors.initials: DH
authors.lastname: Sachs
mesh_terms: D000328:Adult; D001706:Biopsy; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D053804:Granzymes / Q000235:genetics / Q000378:metabolism; D051541:Hepatocyte Nuclear Factor 3-alpha / Q000235:genetics / Q000378:metabolism; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy; D007668:Kidney / Q000033:anatomy & histology / Q000648:ultrastructure; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012333:RNA, Messenger / Q000302:isolation & purification / Q000378:metabolism; D013601:T-Lymphocytes / Q000276:immunology; D018183:Transplantation Chimera / Q000276:immunology*; D019172:Transplantation Conditioning; D014181:Transplantation Immunology; D023001:Transplantation Tolerance / Q000276:immunology*; D014184:Transplantation, Homologous / Q000276:immunology
chemical_list: C496499:FOXA1 protein, human; D051541:Hepatocyte Nuclear Factor 3-alpha; D012333:RNA, Messenger; D053804:Granzymes