无维持免疫抑制的HLA错配肾移植
HLA-mismatched renal transplantation without maintenance immunosuppression.
作者信息
Kawai Tatsuo, Cosimi A Benedict, Spitzer Thomas R, Tolkoff-Rubin Nina, Suthanthiran Manikkam, Saidman Susan L, Shaffer Juanita, Preffer Frederic I, Ding Ruchuang, Sharma Vijay, Fishman Jay A, Dey Bimalangshu, Ko Dicken S C, Hertl Martin, Goes Nelson B, Wong Waichi, Williams Winfred W, Colvin Robert B, Sykes Megan, Sachs David H
机构信息
Transplantation Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, USA.
出版信息
N Engl J Med. 2008 Jan 24;358(4):353-61. doi: 10.1056/NEJMoa071074.
Abstract
Five patients with end-stage renal disease received combined bone marrow and kidney transplants from HLA single-haplotype mismatched living related donors, with the use of a nonmyeloablative preparative regimen. Transient chimerism and reversible capillary leak syndrome developed in all recipients. Irreversible humoral rejection occurred in one patient. In the other four recipients, it was possible to discontinue all immunosuppressive therapy 9 to 14 months after the transplantation, and renal function has remained stable for 2.0 to 5.3 years since transplantation. The T cells from these four recipients, tested in vitro, showed donor-specific unresponsiveness and in specimens from allograft biopsies, obtained after withdrawal of immunosuppressive therapy, there were high levels of P3 (FOXP3) messenger RNA (mRNA) but not granzyme B mRNA.
摘要
五名终末期肾病患者接受了来自HLA单倍型错配的活体亲属供者的联合骨髓和肾脏移植，采用了非清髓性预处理方案。所有受者均出现短暂嵌合和可逆性毛细血管渗漏综合征。一名患者发生了不可逆的体液排斥反应。在其他四名受者中，移植后9至14个月有可能停用所有免疫抑制治疗，自移植后肾功能已保持稳定2.0至5.3年。对这四名受者的T细胞进行体外检测，显示出供者特异性无反应性，并且在停用免疫抑制治疗后获得的同种异体移植活检标本中，P3（FOXP3）信使核糖核酸（mRNA）水平很高，但颗粒酶B mRNA水平不高。
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