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International Journal of Organ Transplantation Medicine، جلد ۴، شماره ۴، صفحات ۰-۰
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عنوان انگلیسی The Effect of Stem Cell Transplantation on Immunosuppression in Living Donor Renal Transplantation: A Clinical Trial
چکیده انگلیسی مقاله Background/Objective: We designed a clinical trial on a group of live-donor renal transplantation (LDRT) patients subjected to pre-transplant stem cell transplantation (SCT) to minimize immunosuppression to low-dose steroid monotherapy. Methods: LDRT patients subjected to pretransplant SCT who had stable graft function for ≥2 years and serum creatinine (SCr) < 2 mg/dL were recruited. Patients with diabetes, hepatitis C/B, rejections, or unwilling to participate, were excluded. They had been subjected to non-myeloablative conditioning of total lymphoid irradiation (TLI)/bortezomib and cyclophosphamide, rabbit-antithymocyte globulin (r-ATG) and rituximab with SCT. The maintenance immunosuppression consisted of calcineurin inhibitors (CNI) and/or anti-proliferative agents and prednisone. Donor-specific antibodies (DSA) and peripheral T-regulatory cells (CD127 low/– /4 + /25 high ) (p-Tregs) were studied before and after withdrawal of major immunosuppressants; graft biopsy was taken after 100 days of withdrawal in willing patients. Rejections were planned to be treated by anti-rejection therapy followed by rescue immunosuppression. Results: All immunosuppression but prednisone, 5–10 mg/day has been successfully withdrawn for a mean of 2.2 years in 76 patients with a mean age of 31.4 years and a mean donor-recipient HLA match of 2.9. The mean SCr of 1.4 mg/dL and p-Tregs of 3.5% was remained stable after withdrawal; DSA status was negative in 35.5% and positive in 47.4% patients. Protocol biopsies in all 10 patients who gave the consent were unremarkable. Conclusion: Stable graft function in LDRT on low-dose steroid monotherapy using pre-transplant SCT under non-myeloablative conditioning with generation of p-Tregs can be achieved successfully and safely.
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نویسندگان مقاله hl trivedi | hl trivedi


av vanikar | av vanikar


vb kute | vb kute


hv patel | hv patel


mr gumber | mr gumber


pr شاه | pr shah


sd dave | sd dave


vb trivedi | vb trivedi


نشانی اینترنتی http://www.ijotm.com/ojs/index.php/IJOTM/article/view/154
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نوع مقاله منتشر شده Original Articles
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