Tolerance induction with donor hematopoietic stem cell infusion in kidney transplantation: a single-center experience in China with a 10-year follow-up

Xuanchuan Wang; Cheng Yang; Linkun Hu; Zheng Wei; Qunye Tang; Bing Chen; Yuan Ji; Ming Xu; Zhaochong Zeng; Ruiming Rong; Tongyu Zhu

doi:10.21037/atm-20-2502a

Tolerance induction with donor hematopoietic stem cell infusion in kidney transplantation: a single-center experience in China with a 10-year follow-up

Ann Transl Med. 2020 Nov;8(21):1378. doi: 10.21037/atm-20-2502a.

Authors

Xuanchuan Wang¹, Cheng Yang^{1

2}, Linkun Hu^{1

3}, Zheng Wei⁴, Qunye Tang¹, Bing Chen⁵, Yuan Ji⁶, Ming Xu¹, Zhaochong Zeng⁵, Ruiming Rong^{1

7}, Tongyu Zhu¹

Affiliations

¹ Department of Urology, Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China.
² Zhangjiang Institute of Fudan University, Shanghai, China.
³ Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China.
⁴ Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁵ Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁶ Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁷ Department of Transfusion, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Background: Immunosuppressive therapy after life-saving kidney transplantation increases the risk of infection, cardiovascular diseases, metabolic diseases, and cancer. To date, four centers (three in the USA and one in South Korea) have reported clinical tolerance trials in kidney transplantation. We performed the first Chinese clinical trial in which kidney transplantation was combined with donor hematopoietic stem cell (DHSC) infusion to induce tolerance. This study summarizes the 10-year follow-up results.

Methods: From 2009 to 2017, 11 donor/recipient pairs underwent living-related kidney transplantation combined with DHSC infusion. Two of the pairs were human leukocyte antigen (HLA)-matched, and nine were HLA-mismatched. DHSCs were mobilized using granulocyte colony-stimulating factor (G-CSF) and harvested 1 day before transplantation. The recipients received consecutive total lymphoid irradiation (TLI) for 3 days before kidney transplantation. The induction drug was anti-thymocyte globulin (ATG). DHSCs were infused on days 2, 4, and 6 post surgery. All patients were followed-up until Dec 2019. Routine laboratory examinations, chimerism, biopsies, and mixed lymphocyte reactions were performed.

Results: One HLA-matched recipient had 30-50% chimerism, while the other patients had less than 1% chimerism. Recipients had donor-specific hyporesponsiveness (DSH) while sustaining normal reactivity to non-donors in mixed lymphocyte reactions. All recipients were followed up for 717-3,918 days. One recipient lost allograft function, and 10 recipients had stable renal function. None of the 11 recipients developed myelosuppression or graft-versus-host disease (GVHD) post transplantation. Our protocol did not increase the risk of infection. Allograft biopsy confirmed that one patient had mild rejection with Banff grade IA, while the other ten recipients did not develop rejection. Five patients were able to reduce the dose of their immunosuppressive therapy.

Conclusions: Our immune tolerance induction protocol, which used DHSC infusion and TLI, achieved low dose immunosuppression with long-term stable kidney allograft survival in Chinese patients.

Keywords: Kidney transplantation; chimerism; hematopoietic stem cell; immune tolerance.