title: Current status of tolerance in kidney transplantation.
abstract: The attainment of tolerance remains a highly desirable goal in recipients of kidney transplants. Achievement of this goal would extend graft survival and eradicate toxicities related to long-term immunosuppression. Understanding mechanisms of tolerance and strategies to induce tolerance - their risk/benefit profiles - is essential for future success.
  
  
  
  Mechanistic studies of spontaneously tolerant kidney transplant recipients have uncovered potential roles for B or regulatory T cells, or both, in the maintenance of tolerance. Mixed hematopoietic chimerism has been the most commonly used approach to induce tolerance. Distinct protocols at three major transplant centers have led to successful withdrawal of immunosuppression in a subset of living donor kidney transplant recipients at the expense of complications such as infections and graft versus host disease. The addition of regulatory cell therapies to tolerance induction protocols could enhance success while minimizing complications.
  
  
  
  This review summarizes the features of spontaneous tolerance in kidney transplant recipients, the results of clinical trials of tolerance induction in the context of living donor kidney transplant, and potential measures to improve the safety and efficacy of tolerance induction strategies.
authors.affiliation: aDivision of Nephrology, Department of Medicine bDivision of Transplantation, Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA.
authors.forename: Sindhu
authors.initials: S
authors.lastname: Chandran
authors.forename: Sandy
authors.initials: S
authors.lastname: Feng
mesh_terms: D001402:B-Lymphocytes / Q000276:immunology; D046528:Chimerism; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology*; D016030:Kidney Transplantation; D050378:T-Lymphocytes, Regulatory / Q000276:immunology