Tolerance induction is considered to be a final goal in the field of organ transplantation. We have performed simultaneous bone marrow and kidney transplantation in MHC mismatched patients to induce transient chimerism and tolerance.

The preconditioning regimen consisted of cytoxan, fludarabine and thymic irradiation. Immuosuppression induction was given as 375 mg/m2 of rituximab 7 days and 2 days before transplantation and 1.5 mg/kg/day of antithymocyte globulin for 3 consecutive days, beginning on the day before transplant. Maintenance immunosuppression were tacrolimus and steroids.

From December 2011 to May 2014, seven MHC mismatched patients received simultaneous bone marrow and kidney transplantation. Median follow-up was 22 months after transplant. Immunosuppression tapering was usually initiated when the patient sustained stable graft function for at least 12 months post-transplant. Immunosuppression was slowly tapered over 6~12 months. Four out of the seven patients were successfully tapered off immunosuppression. One out of the four patients resumed tacrolimus therapy after biopsy-proven acute cellular rejection was diagnosed after 16 months off immunosuppression. The patient was managed with steroid pulse therapy and is currently undergoing a second attempt at immunosuprresion withdrawal. Two patients failed at immunosuppression withdrawal: one patient developed acute rejection during immunosupression tapering and has been kept on tacrolimus without further attempt at withdrawal and the second patient had severe BK virus nephritis which lead to graft loss. One patient is currently undergoing immunosuppression tapering. Five out of the seven patients experienced BK viremia during their post-transplant period.

Conclusion) We have performed seven cases of simultaneous bone marrow and kidney transplantation in MHC mismatched patients. Four out of the seven patients achieved immunosuppression withdrawal.

CITATION INFORMATION: Park H, Lee N, Lee S, Choi G, Kwon C, Kim S, Joh J.-W, Kim M, Kwon Y, Lee S.-K. Tolerance Induction with Donor Bone Marrow Transplantation in Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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