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. We describe the three-year outcome of a 22-year-old patient who developed chronic kidney failure after receiving chemotherapy, local irradiation and a haploidentical HSCT from his father for the treatment of metastatic rhabdomyosarcoma. Five years after HSCT, with the patient in full remission, he received a pre-emptive kidney transplant from his father. Steroid treatment, which had been prescribed for the underlying kidney disease, was discontinued within two months post-kidney transplant. No de novo immunosuppression was given as the patient was determined to be fully chimeric and the avoidance of immunosuppression was considered to be of potential benefit in a patient with previous malignancy. Graft function was excellent throughout the follow-up (36 months post KT: sCreatinine: 1.18 mg/dl, GFR 79.9 ml/min/1.73[sup2]). Surveillance biopsies performed one and twelve months after transplantation confirmed the absence of rejection (BANFF g0, i0, ti0, t0, ah0, cg0, ci0, ct0, mm0, ptc0). To the best of our knowledge, this is one of the first cases of kidney transplantation from the same donor after previous haploidentical HSCT without the use of any de novo immunosuppression. Our results suggest that immunosuppression can be avoided in such cases.

CITATION INFORMATION: Schwarz C, Lawitschka A, Böhmig G, Dauber E, Greinix H, Kozakowski N, Mühlbacher F, Berlakovich G, Wekerle T. Three-Year Outcome After HSCT with Subsequent KT from the Same Haploidentical Donor without Immunosuppression. Am J Transplant. 2016;16 (suppl 3).

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