Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor - A multicenter analysis

Michael Eder; Christoph Schwarz; Michael Kammer; Niels Jacobsen; Masouridi Levrat Stavroula; Morton J Cowan; Tepsiri Chongkrairatanakul; Robert Gaston; Rommel Ravanan; Hideki Ishida; Anette Bachmann; Sergio Alvarez; Martina Koch; Cyril Garrouste; Ulrich A Duffner; Brett Cullis; Nicolaas Schaap; Michael Medinger; Søren Schwartz Sørensen; Eva-Maria Dauber; Georg Böhmig; Heinz Regele; Gabriela A Berlakovich; Thomas Wekerle; Rainer Oberbauer

doi:10.1111/ajt.14970

Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor - A multicenter analysis

Michael Eder, Christoph Schwarz, Michael Kammer, Niels Jacobsen, Masouridi Levrat Stavroula, Morton J Cowan, Tepsiri Chongkrairatanakul, Robert Gaston, Rommel Ravanan, Hideki Ishida, Anette Bachmann, Sergio Alvarez, Martina Koch, Cyril Garrouste, Ulrich A Duffner, Brett Cullis, Nicolaas Schaap, Michael Medinger, Søren Schwartz Sørensen, Eva-Maria DauberGeorg Böhmig, Heinz Regele, Gabriela A Berlakovich, Thomas Wekerle, Rainer Oberbauer

Department of Clinical Medicine

4 Citations (Scopus)

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Abstract

Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 μmol/l (interquartile range [IQR] 72-99) in the tolerant cohort and 118 μmol/l (IQR 99-143) in the control group. Mixed linear-model showed around 29% lower average creatinine levels throughout follow-up in the tolerant group (P < .01). Our data clearly show stable renal graft function without long-term immunosuppression for many years, suggesting permanent donor-specific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients.

Original language	English
Journal	American Journal of Transplantation
Volume	19
Issue number	2
Pages (from-to)	475-487
Number of pages	13
ISSN	1600-6135
DOIs	https://doi.org/10.1111/ajt.14970
Publication status	Published - 1 Feb 2019

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10.1111/ajt.14970Licence: CC BY-NC-ND

Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor—A multicenter analysisFinal published version, 1.05 MBLicence: CC BY-NC-ND

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Eder, M., Schwarz, C., Kammer, M., Jacobsen, N., Stavroula, M. L., Cowan, M. J., Chongkrairatanakul, T., Gaston, R., Ravanan, R., Ishida, H., Bachmann, A., Alvarez, S., Koch, M., Garrouste, C., Duffner, U. A., Cullis, B., Schaap, N., Medinger, M., Sørensen, S. S., ... Oberbauer, R. (2019). Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor - A multicenter analysis. American Journal of Transplantation, 19(2), 475-487. https://doi.org/10.1111/ajt.14970

Eder, M, Schwarz, C, Kammer, M, Jacobsen, N, Stavroula, ML, Cowan, MJ, Chongkrairatanakul, T, Gaston, R, Ravanan, R, Ishida, H, Bachmann, A, Alvarez, S, Koch, M, Garrouste, C, Duffner, UA, Cullis, B, Schaap, N, Medinger, M, Sørensen, SS, Dauber, E-M, Böhmig, G, Regele, H, Berlakovich, GA, Wekerle, T & Oberbauer, R 2019, 'Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor - A multicenter analysis', American Journal of Transplantation, vol. 19, no. 2, pp. 475-487. https://doi.org/10.1111/ajt.14970

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title = "Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor - A multicenter analysis",

abstract = "Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 μmol/l (interquartile range [IQR] 72-99) in the tolerant cohort and 118 μmol/l (IQR 99-143) in the control group. Mixed linear-model showed around 29% lower average creatinine levels throughout follow-up in the tolerant group (P < .01). Our data clearly show stable renal graft function without long-term immunosuppression for many years, suggesting permanent donor-specific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients.",

author = "Michael Eder and Christoph Schwarz and Michael Kammer and Niels Jacobsen and Stavroula, {Masouridi Levrat} and Cowan, {Morton J} and Tepsiri Chongkrairatanakul and Robert Gaston and Rommel Ravanan and Hideki Ishida and Anette Bachmann and Sergio Alvarez and Martina Koch and Cyril Garrouste and Duffner, {Ulrich A} and Brett Cullis and Nicolaas Schaap and Michael Medinger and S{\o}rensen, {S{\o}ren Schwartz} and Eva-Maria Dauber and Georg B{\"o}hmig and Heinz Regele and Berlakovich, {Gabriela A} and Thomas Wekerle and Rainer Oberbauer",

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doi = "10.1111/ajt.14970",

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T1 - Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor - A multicenter analysis

AU - Eder, Michael

AU - Schwarz, Christoph

AU - Kammer, Michael

AU - Jacobsen, Niels

AU - Stavroula, Masouridi Levrat

AU - Cowan, Morton J

AU - Chongkrairatanakul, Tepsiri

AU - Gaston, Robert

AU - Ravanan, Rommel

AU - Ishida, Hideki

AU - Bachmann, Anette

AU - Alvarez, Sergio

AU - Koch, Martina

AU - Garrouste, Cyril

AU - Duffner, Ulrich A

AU - Cullis, Brett

AU - Schaap, Nicolaas

AU - Medinger, Michael

AU - Sørensen, Søren Schwartz

AU - Dauber, Eva-Maria

AU - Böhmig, Georg

AU - Regele, Heinz

AU - Berlakovich, Gabriela A

AU - Wekerle, Thomas

AU - Oberbauer, Rainer

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 μmol/l (interquartile range [IQR] 72-99) in the tolerant cohort and 118 μmol/l (IQR 99-143) in the control group. Mixed linear-model showed around 29% lower average creatinine levels throughout follow-up in the tolerant group (P < .01). Our data clearly show stable renal graft function without long-term immunosuppression for many years, suggesting permanent donor-specific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients.

AB - Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 μmol/l (interquartile range [IQR] 72-99) in the tolerant cohort and 118 μmol/l (IQR 99-143) in the control group. Mixed linear-model showed around 29% lower average creatinine levels throughout follow-up in the tolerant group (P < .01). Our data clearly show stable renal graft function without long-term immunosuppression for many years, suggesting permanent donor-specific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients.

U2 - 10.1111/ajt.14970

DO - 10.1111/ajt.14970

M3 - Journal article

C2 - 29900661

SN - 1600-6135

VL - 19

SP - 475

EP - 487

JO - American Journal of Transplantation

JF - American Journal of Transplantation

IS - 2

ER -

Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor - A multicenter analysis

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