Solgi Ghasem, Gadi Vijayakrishna, Paul Biswajit, Mytilineos Joannis, Pourmand Gholamreza, Mehrsai Abdolrasoul, Ranjbar Moslem, Mohammadnia Mousa, Nikbin Behrouz, Amirzargar Ali Akbar
Immunology Department; School of Medicine; Hamadan University of Medical Sciences; Hamadan, Iran.
Chimerism. 2013 Jul-Sep;4(3):87-94. doi: 10.4161/chim.24719. Epub 2013 May 31.
Augmentation of microchimerism in solid organ transplant recipients by donor bone marrow cells (DBMC) infusion may promote immune hyporesponsiveness and consequently improve long-term allograft survival. Between March 2005 and July 2007, outcomes for 20 living unrelated donor (LURD) primary kidney recipients with concurrent DBMC infusion (an average of 2.19 ± 1.13 x 10⁹ donor cells consisting of 2.66 ± 1.70 x 10⁷ CD34⁺ cells) were prospectively compared with 20 non-infused control allograft recipients given similar conventional immunosuppressive regimens. With five years of clinical follow up, a total of 11 cases experienced rejection episodes (3 DBMI patients vs. 8 controls, p = 0.15). One DBMC-infused patient experienced chronic rejection vs. two episodes (1 biopsy-confirmed) in the control patients. Actuarial and death-censored 5-y graft survival was significantly higher in infused patients compared with controls (p = 0.01 and p = 0.03, respectively). Long-term graft survival was significantly associated with pre-transplant anti-HLA antibodies (p = 0.01), slightly with peripheral microchimerism (p = 0.09) and CD4⁺CD25⁺FoxP3⁺ T cells (p = 0.09). Immunosuppressant dosing was lower in infused patients than controls, particularly for mycophenolate mofetil (p = 0.001). The current findings as well as our previous reports on these patients indicates clinical improvement in long-term graft survival of renal transplant patients resulting from low-dose DBMC infusion given without induction therapy.
通过输注供体骨髓细胞（DBMC）增强实体器官移植受者体内的微嵌合现象，可能会促进免疫低反应性，从而提高长期移植器官的存活率。在2005年3月至2007年7月期间，对20例接受同期DBMC输注的活体非亲属供体（LURD）原发性肾移植受者（平均输入2.19±1.13×10⁹个供体细胞，其中包括2.66±1.70×10⁷个CD34⁺细胞）的预后，与20例接受类似传统免疫抑制方案但未输注DBMC的对照移植受者进行了前瞻性比较。经过五年的临床随访，共有11例患者发生排斥反应（3例输注DBMC患者与8例对照患者，p = 0.15）。1例输注DBMC的患者发生慢性排斥反应，而对照患者中有2例发生（1例经活检证实）。与对照组相比，输注患者的精算和死亡校正5年移植存活率显著更高（分别为p = 0.01和p = 0.03）。长期移植存活率与移植前抗HLA抗体显著相关（p = 0.01），与外周微嵌合现象轻度相关（p = 0.09），与CD4⁺CD25⁺FoxP3⁺ T细胞也轻度相关（p = 0.09）。输注患者的免疫抑制剂剂量低于对照组，尤其是霉酚酸酯（p = 0.001）。目前的研究结果以及我们之前关于这些患者的报告表明，在不进行诱导治疗的情况下给予低剂量DBMC输注，可使肾移植患者的长期移植存活率得到临床改善。
