title: Five-year clinical effects of donor bone marrow cells infusions in kidney allograft recipients: improved graft function and higher graft survival.
abstract: Augmentation of microchimerism in solid organ transplant recipients by donor bone marrow cells (DBMC) infusion may promote immune hyporesponsiveness and consequently improve long-term allograft survival. Between March 2005 and July 2007, outcomes for 20 living unrelated donor (LURD) primary kidney recipients with concurrent DBMC infusion (an average of 2.19 ± 1.13 x 10⁹ donor cells consisting of 2.66 ± 1.70 x 10⁷ CD34⁺ cells) were prospectively compared with 20 non-infused control allograft recipients given similar conventional immunosuppressive regimens. With five years of clinical follow up, a total of 11 cases experienced rejection episodes (3 DBMI patients vs. 8 controls, p = 0.15). One DBMC-infused patient experienced chronic rejection vs. two episodes (1 biopsy-confirmed) in the control patients. Actuarial and death-censored 5-y graft survival was significantly higher in infused patients compared with controls (p = 0.01 and p = 0.03, respectively). Long-term graft survival was significantly associated with pre-transplant anti-HLA antibodies (p = 0.01), slightly with peripheral microchimerism (p = 0.09) and CD4⁺CD25⁺FoxP3⁺ T cells (p = 0.09). Immunosuppressant dosing was lower in infused patients than controls, particularly for mycophenolate mofetil (p = 0.001). The current findings as well as our previous reports on these patients indicates clinical improvement in long-term graft survival of renal transplant patients resulting from low-dose DBMC infusion given without induction therapy.
authors: Immunology Department; School of Medicine; Hamadan University of Medical Sciences; Hamadan, Iran.
authors: Ghasem
authors: G
authors: Solgi
authors: Vijayakrishna
authors: V
authors: Gadi
authors: Biswajit
authors: B
authors: Paul
authors: Joannis
authors: J
authors: Mytilineos
authors: Gholamreza
authors: G
authors: Pourmand
authors: Abdolrasoul
authors: A
authors: Mehrsai
authors: Moslem
authors: M
authors: Ranjbar
authors: Mousa
authors: M
authors: Mohammadnia
authors: Behrouz
authors: B
authors: Nikbin
authors: Ali Akbar
authors: AA
authors: Amirzargar
mesh_terms: D064591:Allografts / Q000502:physiology*; D016026:Bone Marrow Transplantation; D016022:Case-Control Studies; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D016753:Interleukin-10 / Q000235:genetics / Q000276:immunology; D016030:Kidney Transplantation; D011446:Prospective Studies; D053773:Transforming Growth Factor beta1 / Q000235:genetics / Q000276:immunology; D018183:Transplantation Chimera / Q000276:immunology; D016896:Treatment Outcome; D061349:Unrelated Donors
chemical_list: C508609:IL10 protein, human; D053773:Transforming Growth Factor beta1; D016753:Interleukin-10
keywords: donor bone marrow infusion; kidney allograft; microchimerism
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