Unexplained post-renal transplant tolerance: a case report

Abstract

Achievement of an immunosuppression-free condition defined as clinical operational tolerance is an ideal goal. We hereby report a case of clinical operational tolerance in a patient whose allograft is functioning normally, without immunosuppression, for more than 3 years. The patient withdrew from immunosuppression in 2011 following which his serum creatinine was 1.34 mg/dl and proteinuria was 178 mg/24 h. Flowcytometric studies showed an elevated number of B lymphocytes and NK cells. IL-10 cytokine levels had increased, whereas those of IFN-γ decreased, suggesting that both B lymphocytes and NK cells, with their immunoregulatory function, contribute to the maintenance of long-term graft function. Consequently, further studies in understanding the interactions of NK cells and B lymphocytes may give us a better insight into the underlying mechanisms that underpin organ tolerance.

Operational tolerance in kidney transplantation and associated biomarkers

“…In animal studies, the claim that an individual has become tolerant has to meet very stringent criteria [46]. [18] 1976 1 40 months Uehling [19] 1976 1 36 months Seigler (reply to Uehling) [19] 1976 1 > 4 years Zoller [20] 1980 14 1-8 years Strober [21,22] 1989 2 69 months and 12 years Burlingham [23,24] 1995 1 7 years Fischer [25] 1996 1 9 years Christensen [26] 1998 1 > 3 years Van Buskirk [27] 2000 2 § > 5 and > 27 years Cai [28] 2004 1 § 32 years Starzl [5] 2004 7 3-38 years University of Nantes, France [29,30] 2006 27 ‡ 2-20 years (one missing data) Xu [31] 2007 2 Not available Indices of Tolerance (IOT) [32] 2010 11 2-21 years Immune Tolerance Network (ITN) [33][34][35] 2010 39 Divided into 3 groups: (1) n 5 25, mean time: 16 6 10Á4 (2) n 5 7, mean time: 14 6 17Á1 (3) n 5 7, not available Azancot [36] 2011 2 ‡ 14 months and > 6 years Inal [37] 2011 1 8 years University of São Paulo, Brazil [38][39][40] 2012 5 1Á5-8 years Becker [41] 2012 4 1-19 years Roedder [42] 2014 69 Not available GAMBIT study [43,44] 2016 14 # 1 common 1-22Á5 years DESCARTES-Nantes Survey [8] 2016 40 # 1 common 1-25 years (5 missing data) Kesiraju [45] 2016 1 > 3 years Total 41 years of reports 247 -It is l...…”

Decreased NK cell immunity in kidney transplant recipients late post-transplant and increased NK-cell immunity in patients with recurrent miscarriage

“…Sagoo et al and Bohne et al published that tolerant kidney and liver transplant patients displayed an expansion of peripheral blood NK lymphocytes [ 4 , 5 ]. Kesiraju et al reported on increased NK- and B-cells, increased serum IL10 and decreased serum interferon-gamma (IFNy) in a kidney transplant patient with operational tolerance [ 6 ].…”