Lymphoid irradiation, donor stem cells eliminate immunosuppressant use post-renal transplant
WEDNESDAY, Oct. 5 (HealthDay News) -- Most patients undergoing human leukocyte antigen (HLA)-matched kidney-transplantation are able to discontinue anti-rejection medications, after receiving enriched CD34+ hematopoietic progenitor cells, total lymphoid irradiation, and anti-T-cell antibodies, according to a letter published in the Oct. 6 issue of the New England Journal of Medicine.
John D. Scandling, M.D., from the Stanford University School of Medicine in California, and colleagues developed a protocol to eliminate the need for immunosuppressive drugs in kidney-transplant recipients. In a proof-of-concept study, 12 recipients of HLA-matched kidneys received a donor-cell infusion of highly enriched CD34+ hematopoietic progenitor cells mixed with CD3+ T cells, and a conditioning regimen of total lymphoid irradiation and anti-T-cell antibodies after transplantation. All the patients received mycophenolate mofetil for one month, and cyclosporine for at least six months after transplantation. Cyclosporine was discontinued six to 17 months after transplantation.
In a follow-up of at least 12 to 36 months, the investigators found that the anti-rejection drugs were discontinued in eight patients with no rejection episodes. Post-discontinuation, a study of creatinine clearances, proteinuria, and histopathological parameters revealed no evidence of chronic rejection or graft injury in any patient. Immunosuppressive drugs were discontinued in four patients due to focal segmental glomerulosclerosis or rejection episodes, but standard medications reversed the rejection and returned serum creatinine levels to baseline. Maintenance immunosuppressive agents were then resumed without evidence of graft dysfunction or chronic rejection.
"The majority of patients were able to discontinue anti-rejection medications, and all patients had excellent graft function at the last observation point," the authors write.
One author disclosed financial relationships with several pharmaceutical companies.