Transplantation · 2013
A randomized pilot study of donor stem cell infusion in living-related kidney transplant recipients receiving alemtuzumab.
СтатьяРандомизированное исследованиеПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Ciancio Gaetano, Sageshima Junichiro, Akpinar Edip, Gaynor Jeffrey J, Chen Linda, Zarak Alberto, Hanson Lois, Tueros Lissett, Guerra Giselle, Mattiazzi Adela, Kupin Warren, Roth David, Ricordi Camillo, Burke George W
Аннотация
BACKGROUND: Transplant tolerance would remove the need for maintenance immunosuppression while improving survival and quality of life.
METHODS: A prospective, randomized pilot study was undertaken to assess the safety and efficacy of donor stem cell infusion (DSCI) in living-related kidney transplant recipients treated with alemtuzumab (C1H) induction and tacrolimus and mycophenolate maintenance with switch to sirolimus and weaning over 2 years.
RESULTS: Four patients received DSCI; five patients were controls. Graft failure occurred in two patients in the DSCI arm. Recurrence of glomerular disease occurred in two DSCI recipients, leading to graft loss in one. Biopsy-proven acute rejection episodes occurred in three patients (two in the DSCI vs. one in the control). One DSCI patient, with recurrence, subsequently developed antibody-mediated rejection leading to graft failure. In the remaining two DSCI patients, weaning was attempted but was not successful. All (4 of 4) DSCI patients had biopsy-proven chronic allograft injury and/or recurrence.
CONCLUSION: DSCI with C1H induction and a steroid-free maintenance regimen in a small group of patients failed to induce tolerance, with suboptimal patient and graft survival. The results do not justify extension of this particular trial and underscore the importance of patient selection, specifically avoidance of patients with glomerulopathies whose recurrence may obscure potential benefit.
METHODS: A prospective, randomized pilot study was undertaken to assess the safety and efficacy of donor stem cell infusion (DSCI) in living-related kidney transplant recipients treated with alemtuzumab (C1H) induction and tacrolimus and mycophenolate maintenance with switch to sirolimus and weaning over 2 years.
RESULTS: Four patients received DSCI; five patients were controls. Graft failure occurred in two patients in the DSCI arm. Recurrence of glomerular disease occurred in two DSCI recipients, leading to graft loss in one. Biopsy-proven acute rejection episodes occurred in three patients (two in the DSCI vs. one in the control). One DSCI patient, with recurrence, subsequently developed antibody-mediated rejection leading to graft failure. In the remaining two DSCI patients, weaning was attempted but was not successful. All (4 of 4) DSCI patients had biopsy-proven chronic allograft injury and/or recurrence.
CONCLUSION: DSCI with C1H induction and a steroid-free maintenance regimen in a small group of patients failed to induce tolerance, with suboptimal patient and graft survival. The results do not justify extension of this particular trial and underscore the importance of patient selection, specifically avoidance of patients with glomerulopathies whose recurrence may obscure potential benefit.
Предметные рубрики MeSH
AdultAlemtuzumabAntibodies, Monoclonal, HumanizedDrug SubstitutionFamilyFemaleFloridaGraft RejectionGraft SurvivalHumansImmunosuppressive AgentsKidney TransplantationLiving DonorsMaleMiddle AgedMycophenolic AcidPilot ProjectsProspective StudiesRecurrenceSirolimusStem Cell TransplantationTacrolimusTime FactorsTransplantation ToleranceTreatment OutcomeYoung Adult