Kidney transplantation with bone marrow augmentation: five-year outcomes

Abstract

Bone marrow augmentation in renal transplant recipients has been performed in a small number of centers, in an attempt to augment chimerism and/or provide donor-specific immunomodulation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] In this report, we present our experience with bone marrow augmentation in renal transplantation over the past 7 years. PATIENT AND METHODSBetween December 14, 1992, and January 1, 2000, 124 kidney/bone marrow transplants were performed. There were 51 (41%) cadaveric kidney, 59 (48%) kidney/pancreas, 8 (6%) kidney/ islet, and 6 (5%) living-related kidney recipients. The mean recipient age was 40.4 ± 10.5 years. The dosage of unmodified bone marrow was 3 to 5 × 10 8 cells/kg, given either as a single infusion (n = 86; 69%), or as multiple infusions (n = 38, 31%). 15 The mean donor age was 33.0 ± 15.5 years, and the mean cold ischemia time was 17.8 ± 9.6 hours. The mean number of HLA matches and mismatches was 1.9 ± 1.3 and 3.8 ± 1.3, respectively. Eighty patients who could have undergone kidney/bone marrow transplantation but did not because of lack of bone marrow availability were studied as controls. There were 45 (56%) cadaveric kidney, 32 (40%) kidney/pancreas, 2 (3%) kidney/islet, and 1 (1%) living-related kidney recipients in the control group. This was not a randomized trial; the availability of donor bone marrow was sporadic, and the total case material accounted for only about 10% of the transplants performed during this time period. The mean recipient age was 43.8 ± 10.8 years. The mean donor age was 36.7 ± 17.3 years, and the mean cold ischemia time was 21.9 ± 10.0 hours. The mean number of HLA matches and mismatches was 2.2 ± 1.5 and 3.5 ± 1.6, respectively.Immunosuppression was with tacrolimus-based immunosuppression, as previously described. 6,16 Antibody induction was not given, nor was radiation or cytoreduction therapy.The bone marrow and control protocols were submitted to and approved by the Institutional Review Board of the University of Pittsburgh. RESULTSThe mean follow up was 36.4 ± 23.2 months. In the K/BM group, the 1-and 5-year actuarial patient survival was 98% and 85%, and the 1-and 5-year actuarial graft survival was 97% and 76%. In the control group, the 1-and 5-year actuarial patient survival was 97% and 85%, and the 1-and 5-year actuarial graft survival was 93% arid 71 % (P = NS).

Tolerance Induction: Historical and Scientific Background and Recent Development in Clinical Practice

“…A similar number of lung transplantations were done. Graft survival was the same in both groups, but obliterate bronchiolitis occurred at a lower rate, only 5% in the BM treated patients (38).…”