A randomized pilot study of donor stem cell infusion in living-related kidney transplant recipients receiving alemtuzumab

Gaetano Ciancio, Junichiro Sageshima, Edip Akpinar, Jeffrey J. Gaynor, Linda Chen, Alberto Zarak, Lois Hanson, Lissett Tueros, Giselle Guerra, Adela Mattiazzi, Warren Kupin, David Roth, Camillo Ricordi, George W. Burke

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

BACKGROUND: Transplant tolerance would remove the need for maintenance immunosuppression while improving survival and quality of life. METHODS: A prospective, randomized pilot study was undertaken to assess the safety and efficacy of donor stem cell infusion (DSCI) in living-related kidney transplant recipients treated with alemtuzumab (C1H) induction and tacrolimus and mycophenolate maintenance with switch to sirolimus and weaning over 2 years. RESULTS: Four patients received DSCI; five patients were controls. Graft failure occurred in two patients in the DSCI arm. Recurrence of glomerular disease occurred in two DSCI recipients, leading to graft loss in one. Biopsy-proven acute rejection episodes occurred in three patients (two in the DSCI vs. one in the control). One DSCI patient, with recurrence, subsequently developed antibody-mediated rejection leading to graft failure. In the remaining two DSCI patients, weaning was attempted but was not successful. All (4 of 4) DSCI patients had biopsy-proven chronic allograft injury and/or recurrence. CONCLUSION: DSCI with C1H induction and a steroid-free maintenance regimen in a small group of patients failed to induce tolerance, with suboptimal patient and graft survival. The results do not justify extension of this particular trial and underscore the importance of patient selection, specifically avoidance of patients with glomerulopathies whose recurrence may obscure potential benefit.

Original languageEnglish (US)
Pages (from-to)800-806
Number of pages7
JournalTransplantation
Volume96
Issue number9
DOIs
StatePublished - Nov 15 2013

Keywords

  • Alemtuzumab
  • Allograft tolerance
  • Donor-derived hematopoietic stem cells
  • Living-related kidney transplantation

ASJC Scopus subject areas

  • Transplantation

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