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Combined simultaneous kidney/bone marrow transplantation

Shapiro, R and Rao, AS and Fontes, P and Zeevi, A and Jordan, M and Scantlebury, VP and Vivas, C and Gritsch, HA and Corry, RJ and Egidi, F and Rugeles, MT and Rilo, H and Aitouche, A and Demetris, AJ and Rosner, G and Trucco, M and Rybka, W and Irish, W and Fung, JJ and Starzl, TE (1995) Combined simultaneous kidney/bone marrow transplantation. Transplantation, 60 (12). 1421 - 1425. ISSN 0041-1337

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Abstract

On the basis of observations in patients with longterm (28-30 years) renal allograft survival, all of whom had evidence of systemic microchimerism, we began a program of combined simultaneous kidney/bone marrow transplantation. Between 12/14/92, and 10/31/94,36 kidney transplant recipients received 3-5 x 108 unmodified bone marrow cells/kg; 6 patients also received pancreatic islets, and 7 patients also received a pancreas. The mean recipient age was 39.0 ±10.8 years, and the mean donor age was 31.8 ±16.1 years; the mean cold ischemia time was 23.0±9.1 hr. Twenty control patients received kidneys alone, mainly because of refusal by the donor family to consent to vertebral body recovery; 3 of these patients also received a pancreas. The mean recipient age was 47.9 ±11.7 years, and the mean donor age was 41.5 ±17.9 years; the mean cold ischemia time was 28.6 ±6.2 hr. All patients received tacrolimus-based therapy, without radiation, cytoreduction, or induction antilymphocyte preparations. Blood was drawn prior to and at regular intervals after transplantation for detection of chimerism and for immunologic studies. With a mean follow-up of 11.1 ±5.8 months, all 36 study patients are alive, and 33 (92%) have functioning allografts with a mean serum creatinine of 1.9±1.2 mg/dl and a BUN of 26±9 mg/dl. Graft vs. host disease was not seen in any patient. The incidence of rejection was 72%; 11% of the patients required OKT3 or ATG for steroid-resistant rejection. The incidence of CMV was 14%, and that of delayed graft function was 17%. A total of 18 (90%) control patients are alive, and 17 (85%) have functioning allografts, with a mean serum creatinine of 2.1 ±1.3 mg/ dl, and a BUN of 30±13 mg/dl. The incidence of rejection was 60%, and 10% required OKT3 or ATG. CMV was seen in 15%, and delayed graft function in 20% (P=NS). In the study patients, chimerism was detected in the peripheral blood of 30 of 31 (97%) evaluable patients by either PCR or flow cytometry. In the control patients, chimerism was seen in 9 of 14 (64%) evaluable patients (P<.02). Decreasing donor-specific responsiveness was seen in 6/29 (21%) evaluable study, and 4/14 (29%) evaluable control patients (P=NS). We conclude that combined kidney/bone marrow transplantation is associated with acceptable patient and graft survival, augmentation of chimerism, and no change in the early events after transplantation. © 1995 by Williams & Wilkins.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Shapiro, R
Rao, AS
Fontes, P
Zeevi, A
Jordan, M
Scantlebury, VP
Vivas, C
Gritsch, HA
Corry, RJ
Egidi, F
Rugeles, MT
Rilo, H
Aitouche, A
Demetris, AJ
Rosner, G
Trucco, Mmnt@pitt.eduMNT
Rybka, W
Irish, W
Fung, JJ
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 27 December 1995
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 60
Number: 12
Page Range: 1421 - 1425
DOI or Unique Handle: 10.1097/00007890-199560120-00009
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062121706, Starzl CV No. 1820
Date Deposited: 08 Apr 2010 17:31
Last Modified: 21 Jan 2019 15:55
URI: http://d-scholarship.pitt.edu/id/eprint/5206

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