title: Kidney Transplantation With Corticosteroids Alone After Haploidentical HSCT From The Same Donor.
abstract: BACKGROUND
  Allogeneic hematopoietic stem cell transplantation (HSCT) can lead to donor-specific tolerance. Patients reported in the literature that underwent kidney transplantation (KT) after a previous HSCT from the same haploidentical donor typically received short-term immunosuppression, mainly for safety reasons and concerns of triggering graft-versus-host disease.
  
  
  METHODS
  We describe the case of a 22-year-old patient who developed chronic kidney failure after receiving haploidentical HSCT from his father for the treatment of metastatic rhabdomyosarcoma. Five years after HSCT, he received a preemptive kidney transplant from his father. Steroid treatment, which had been prescribed for the underlying kidney disease, was withdrawn within 2 months posttransplant, and no de novo immunosuppression was given. Donor-specific tolerance was assessed with mixed lymphocyte reaction and INF-γ ELISPOT before (D0) and after KT (D9). Furthermore, the exact level of donor-derived T cells was measured with real-time polymerase chain reaction before and 1 year after KT.
  
  
  RESULTS
  In vitro assays (mixed lymphocyte reaction and ELISPOT) revealed donor-specific tolerance before and after transplantation, respectively. The number of recipient-derived T cells was low before KT and virtually did not change over time (0.0139% ± 0.0039 and 0.0120% ± 0.0067; P = NS). Graft function was excellent throughout the follow-up (36 months post KT: serum creatinine, 1.18 mg/dL). Protocol biopsies performed 1 and 12 months after transplantation confirmed the absence of rejection.
  
  
  CONCLUSIONS
  This is one of the first cases of kidney transplantation from the same donor after previous haploidentical HSCT with a corticosteroid taper alone. Our results suggest that immunosuppression can be avoided in such cases.
authors.affiliation: 1 Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria. 2 Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria. 3 St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria. 4 Department of Internal Medicine III/Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria. 5 Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria. 6 Department of Internal Medicine I, Division of Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria. 7 Division of Hematology, Medical University of Graz, Graz, Austria. 8 Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwarz
authors.forename: Anita
authors.initials: A
authors.lastname: Lawitschka
authors.forename: Georg A
authors.initials: GA
authors.lastname: Böhmig
authors.forename: Eva M
authors.initials: EM
authors.lastname: Dauber
authors.forename: Hildegard
authors.initials: H
authors.lastname: Greinix
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kozakowski
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mühlbacher
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Berlakovich
authors.forename: Thomas
authors.initials: T
authors.lastname: Wekerle
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D014019:Tissue Donors
chemical_list: D000305:Adrenal Cortex Hormones