title: Stem cell transplantation in living donor renal transplantation for minimization of immunosuppression.
abstract: BACKGROUND
  We present our experience of living-donor renal transplantation (LDRT) using pretransplant stem cell transplantation (SCT) where we have successfully achieved minimization of immunosuppression.
  
  
  METHODS
  Nine hundred sixteen patients underwent LDRT between 2007 and 2011: 606 under tolerance induction protocol (TIP) and 310 with our usual triple immunosuppression of calcineurin inhibitors (CNI), mycofenolate sodium (MMF), and prednisone (controls). The test group (TIP) was stratified into group 1, 1 haplomatch or greater (n=392), group 3, less than 1 haplomatch (n=214); controls were similarly stratified to group 2, 1 haplomatch or greater (n=179) and group 4, less than 1 haplomatch (n=131). The TIP consisted of donor-specific transfusion, adipose tissue-derived mesenchymal and hematopoietic stem cell transplantation, and nonmyeloablative conditioning with total lymphoid irradiation, cyclophosphamide, and rabbit-antithymocyte globulin. Posttransplant IS consisted of prednisone, CNI, or MMF, all in low doses.
  
  
  RESULTS
  Four-year patient survival was 93.5%, 90.7%, 88.7%, and 82.7% in groups 1 through 4, respectively, and death-censored 4-year allograft survival was 94.8%, 95.4%, 94.5%, and 74.6%, respectively. Mean serum creatinine (mg/dL) for groups 1 through 4, respectively, at 4 years was 1.26, 1.57, 1.29, and 2.1. The number of rejection episodes was highest in group 4 and lowest in group 1. Minimization of IS was successfully achieved in 82.9% patients in group 1 and in 61.7% patients in group 3, whereas no minimization in groups 2 and 4. Stem cell transplantations were safe.
  
  
  CONCLUSIONS
  Stem cell transplantation is effective in IS minimization in LDRT resulting in good graft function and patient and graft survival at 4 years.
authors.affiliation: Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, GR Doshi and KM Mehta Institute of Kidney Diseases and Research Centre-Dr. HL Trivedi Institute of Transplantation Sciences, Gujarat, India. vanikararuna@yahoo.com
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: Hargovind L
authors.initials: HL
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007108:Immune Tolerance; D016030:Kidney Transplantation / Q000401:mortality; D019520:Living Donors; D015182:Lymphatic Irradiation; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D008875:Middle Aged