PMID- 37231903
OWN - NLM
STAT- MEDLINE
DCOM- 20231004
LR  - 20231024
IS  - 2235-3186 (Electronic)
IS  - 1660-8151 (Linking)
VI  - 147
IP  - 10
DP  - 2023
TI  - Use of Mixed Lymphocyte Reaction Assay to Evaluate Immune Tolerance before Kidney 
      Transplantation with an Immunosuppression-Free Protocol following Hematopoietic 
      Stem Cell Transplantation from the Same Donor.
PG  - 621-626
LID - 10.1159/000531031 [doi]
AB  - Several cases of kidney transplantation after hematopoietic stem cell 
      transplantation (HSCT) from the same donor for end-stage renal disease have been 
      reported. In those cases, immunosuppressive drugs were discontinued since immune 
      tolerance was supposed to be induced. Theoretically, the recipient's immune 
      system recognizes the kidney allograft as its own tissue with the same human 
      leukocyte antigen (HLA) profile, and the kidney allograft will not be rejected, 
      even without the use of immunosuppressive agents. However, almost all recipients 
      receive immunosuppressants in the early stages after kidney transplantation owing 
      to concerns of acute rejection. Here, we report a successful case of post-HSCT 
      kidney transplantation without the use of immunosuppressive drugs, in which a 
      mixed lymphocyte reaction (MLR) assay was used to evaluate immune tolerance 
      before kidney transplantation. The patient was a 25-year-old woman. Five years 
      prior, she developed acute myeloid leukemia and underwent HLA-half-matched 
      peripheral blood stem cell transplantation. Thereafter, she was in remission of 
      the acute myeloid leukemia, but 1 year later, she developed renal 
      graft-versus-host disease. Subsequently, the patient's renal function gradually 
      deteriorated to end-stage renal failure, and she underwent kidney transplantation 
      with the previous stem cell donor: her mother. HLA typing of donor and recipient 
      showed a complete chimerism in the peripheral blood. The pretransplantation 
      complement-dependent cytotoxic crossmatch and flow cytometric T-cell crossmatch 
      results were both negative, and HLA antibody measurements were all negative. The 
      MLR assay revealed no T-lymphocyte reaction to the donor; therefore, 
      immunosuppressants were not used. Two years after transplantation, the patient's 
      serum creatinine concentration was around 0.8 mg/dL (down from 4 mg/dL before 
      transplantation). No abnormalities were observed in a renal biopsy performed 
      after 3 months. Our study, along with others, indicates that immune tolerance to 
      a donor develops in post-HSCT kidney transplantation from the same donor.
CI  - (c) 2023 S. Karger AG, Basel.
FAU - Nonoyama, Sho
AU  - Nonoyama S
AD  - Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
FAU - Hotta, Kiyohiko
AU  - Hotta K
AD  - Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
FAU - Iwahara, Naoya
AU  - Iwahara N
AD  - Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
FAU - Tanabe, Tatsu
AU  - Tanabe T
AD  - Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
FAU - Hirose, Takayuki
AU  - Hirose T
AD  - Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
FAU - Harada, Shigeru
AU  - Harada S
AD  - Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
FAU - Junichi, Sugita
AU  - Junichi S
AD  - Department of Hematology, Hokkaido University Hospital, Sapporo, Japan.
FAU - Nakazawa, Daigo
AU  - Nakazawa D
AD  - Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, 
      Japan.
FAU - Shigematsu, Akio
AU  - Shigematsu A
AD  - Department of Hematology, Kushiro Rosai Hospital, Kushiro, Japan.
FAU - Otsuka, Takuya
AU  - Otsuka T
AD  - Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
FAU - Shinohara, Nobuo
AU  - Shinohara N
AD  - Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
LA  - eng
PT  - Case Reports
DEP - 20230511
PL  - Switzerland
TA  - Nephron
JT  - Nephron
JID - 0331777
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Humans
MH  - Female
MH  - Adult
MH  - *Kidney Transplantation/methods
MH  - Lymphocyte Culture Test, Mixed
MH  - *Hematopoietic Stem Cell Transplantation/methods
MH  - Immune Tolerance
MH  - Immunosuppressive Agents/therapeutic use
MH  - *Kidney Failure, Chronic/surgery
OTO - NOTNLM
OT  - End-stage kidney disease
OT  - Hematopoietic stem cell transplantation
OT  - Kidney transplantation
OT  - Mixed lymphocyte reaction
OT  - Tolerance
EDAT- 2023/05/26 06:42
MHDA- 2023/10/04 06:43
CRDT- 2023/05/26 03:50
PHST- 2023/03/08 00:00 [received]
PHST- 2023/04/13 00:00 [accepted]
PHST- 2023/10/04 06:43 [medline]
PHST- 2023/05/26 06:42 [pubmed]
PHST- 2023/05/26 03:50 [entrez]
AID - 000531031 [pii]
AID - 10.1159/000531031 [doi]
PST - ppublish
SO  - Nephron. 2023;147(10):621-626. doi: 10.1159/000531031. Epub 2023 May 11.