Work

Combined Kidney/Bone Marrow Transplantationa Evidence Of Augmentation Of Chimerism

Year: 1995

Type: article

Abstract: Recent studies on patients who have maintained stable hepatic and renal allograft function for 10-28 vears have revealed systemIc microchimerism in all (1.2l.With the belief that this is the essential mechanism of allograft acceptance.we sought to augment the spontaneous chimerism in newly transplanted recipients.and began a program of combined simultaneous kidney/bone marrow transplantation without pretransplant radiation or other cytoreduction therapy (3), Postoperative immunosuppression was with FK506 and prednisone.using these drugs in the same way as in standard practice (4).Seventeen cadaver kidney recipients were entered into the bone marrow augmentation series up to .June 1994.All are well.We report here the first 10.whose simultaneous kidneybone marrow transplantations were between December 14. 1992 and December 14. 1993.'!\vo of them also received pancreatic islets.The mean recipient age was 41.32: 13.7 years (range 24.6-ti3.4).All patients were undergoing their first transplantatIOn and had a panel-reactive antibodv level of less than 150.The mean number of HLA matches' and mismatches was zAc: 1.3 (range 1-5) and 3.22: 1.8 (range 1-6\.respectively.The mean donor age was :25.02:7.5 vears.and the mean cold ischemia time was 26.52:9.4hr.-Eight control patients undergoing their first cadaveric kidney transplantation but not receiving bone marrow were also studied.The most common reason for not performing the combined procedure in the control cases was refusal of the donor family to consent to vertebral body recovery.Their mean age was 44.02:11.0years (range 29.7-59.8).The mean number of HLA matches and mismatches was 3.5:!: 1.9 (range 1-til and 2.4c:2.0(range O-Sl.The mean donor age was 50.32: 12.4 years.and the mean cold ischemia time was 31.32:3.6hr.Neither Irradiation nor any other kind of recipient precon-ditiOnIng was used in the bone marrow recipients.All blood ,

Source: Transplantation

DOI: 10.1097/00007890-199501270-00026