title: Stable graft function on low-dose steroid monotherapy in spite of donor-specific antibodies in renal transplantation combined with stem cell infusion.
abstract: Transplantation using immunosuppression/induction therapies has controlled acute rejections; however, there is no answer for chronic graft attrition. Donor-specific antibodies (DSA) are believed to cause antibody mediated rejections eventually causing chronic graft loss. Regulatory T cells (T-regs) are believed to protect the graft from immune injury. We report a 53-year-old woman transplanted with her son's kidney using donor-specific transfusion and stem cells (SC) under non-myeloablative conditioning of cyclophosphamide, anti-T and anti-B-cell antibodies and Bortezomib. The patient was on low-dose steroid monotherapy under immune monitoring of DSA and serum creatine. Graft biopsy at 1 and 3.5 years post-transplant was unremarkable in spite of the presence of DSA. Peripheral T-regs (pTregs) at 3.5 years post-transplant were 3.54%. This case shows that DSA are not necessarily detrimental to the renal allograft. We further hypothesise that pTregs were induced from SC and sustained to protect this graft from cytotoxic T cells and DSA.
authors.affiliation: Department of Nephrology and Transplantation Medicine, G R Doshi and K M Mehta Institute of Kidney Diseases & Research Centre (IKDRC), Ahmedabad, Gujarat, India. ikdrcad1@sancharnet.in
authors.forename: Hargovind L
authors.initials: HL
authors.lastname: Trivedi
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: Shruti D
authors.initials: SD
authors.lastname: Dave
mesh_terms: D000906:Antibodies / Q000276:immunology*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D033581:Stem Cell Transplantation; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D013256:Steroids