Living related liver transplant following bone marrow transplantation from same donor: Long‐term survival without immunosuppression

Abstract

We report long-term (seven yr) immunological tolerance in a 16-yr-old boy, to a liver allograft donated by his father following a bone marrow transplant at age 2.5 yr from the same donor. The bone marrow transplant was complicated by severe GVHD leading to liver failure and the ensuing need for a liver transplant, performed under planned avoidance of immunosuppression. At one wk post-transplant, although a liver biopsy was histologically compatible with acute rejection, favorable clinical and biochemical evolution precluded initiating immunosuppressive therapy, thus highlighting the need for caution when interpreting early histological changes so that administration of unnecessary immunosuppression can be avoided. Induction of tolerance in transplant recipients remains an elusive goal. In those patients who had received conventional bone marrow transplants and had endured the consequences of GVHD, development of macrochimerism may allow immunosuppression-free solid organ transplantation from the same donor.

Pediatric liver transplantation: Personal perspectives on historical achievements and future challenges

“…We observed such a child showing a persistent state of immunological tolerance 7 years after transplant without IS at any stage. Appropriate studies showed complete donor chimerism in the recipient's peripheral blood Can immunological tolerance be induced in clinical practice?…”

“…Appropriate studies showed complete donor chimerism in the recipient's peripheral blood. (55) Can immunological tolerance be induced in clinical practice? Microchimerism, with less than 1% of donor cells detected, might be the clue.…”

Living Donor Liver Transplantation in Children

“…No immunosuppression was given to 1 patient who received, before LT, bone marrow transplantation from the same LD. 10 Acute rejection (AR) was diagnosed in case of elevated liver enzymes and/or cholestasis with a biopsy-proven graft rejection (BANFF score) 11 and treatment by intravenous methylprednisolone.…”

Operational tolerance: Past lessons and future prospects

“…In regard to type of transplant, ie, LDLT versus DDLT or pediatric versus adult, the Kyoto group demonstrated a high IS withdrawal success rate (42.6%) fairly early after pediatric LDLT 55, 56. Other case series have reported IS withdrawal in recipients of simultaneous or staggered donor hematopoietic cell transplantation and LDLT 51, 68‐71. The success of these approaches may be in part due to greater HLA similarities between the related donor/recipient pairs or the avoidance of significant ischemia/reperfusion injury by the nature of the procedure.…”