title: Unexplained post-renal transplant tolerance: a case report.
abstract: Achievement of an immunosuppression-free condition defined as clinical operational tolerance is an ideal goal. We hereby report a case of clinical operational tolerance in a patient whose allograft is functioning normally, without immunosuppression, for more than 3 years. The patient withdrew from immunosuppression in 2011 following which his serum creatinine was 1.34 mg/dl and proteinuria was 178 mg/24 h. Flowcytometric studies showed an elevated number of B lymphocytes and NK cells. IL-10 cytokine levels had increased, whereas those of IFN-γ decreased, suggesting that both B lymphocytes and NK cells, with their immunoregulatory function, contribute to the maintenance of long-term graft function. Consequently, further studies in understanding the interactions of NK cells and B lymphocytes may give us a better insight into the underlying mechanisms that underpin organ tolerance.
authors.affiliation: Department of Immunology and Biochemistry, Transimmun-Transplantation Immunology and Research Center, Somajiguda, Hyderabad, 500082, India. kesirajusailaja@gmail.com.
authors.forename: Sailaja
authors.initials: S
authors.lastname: Kesiraju
authors.affiliation: Kidney Transplant Unit, Mahavir Hospital and Research Center, AC Guards, Hyderabad, India.
authors.forename: Uma Maheswara Rao
authors.initials: UM
authors.lastname: Ch
authors.affiliation: Department of Nephrology and Transplantation, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Purna
authors.initials: P
authors.lastname: Paritala
authors.affiliation: Department of Nephrology and Transplantation, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Sreedhar
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Nephrology and Transplantation, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: V S
authors.initials: VS
authors.lastname: Reddy
authors.affiliation: Department of Immunology and Biochemistry, Transimmun-Transplantation Immunology and Research Center, Somajiguda, Hyderabad, 500082, India.|Kidney Transplant Unit, Mahavir Hospital and Research Center, AC Guards, Hyderabad, India.|Department of Nephrology and Transplantation, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: S
authors.initials: S
authors.lastname: Sahariah
mesh_terms: D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology*; D006084:Graft Rejection / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D007165:Immunosuppression Therapy; D016753:Interleukin-10 / Q000378:metabolism*; D016030:Kidney Transplantation; D007694:Killer Cells, Natural / Q000276:immunology*; D008297:Male; D035781:Siblings; D023001:Transplantation Tolerance; D028761:Withholding Treatment
chemical_list: D006680:HLA Antigens; D016753:Interleukin-10
keywords: B lymphocyte; Immunosuppression; NK cell; Renal transplant; Tolerance