Hong Kong Journal of Nephrology
Volume 7, Issue 1 , Pages 22-26, April 2005

Effects of a Tolerance Induction Protocol in Renal Allograft Recipients — the Ahmedabad Experience

  • Aruna V. Vanikar

      Affiliations

    • Department of Immunohematology, Institute of Kidney Diseases & Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
    • Department of Pathology, Laboratory Medicine and Transfusion Services, Institute of Kidney Diseases & Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr. Aruna V. Vanikar, Department of Pathology, Laboratory Medicine and Transfusion Services, and Department of Immunohematology, Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad 380-016, Gujarat, India. Fax: (+91) 79-2268-5454
    • ,
  • Hargovind L. Trivedi

      Affiliations

    • Department of Transplantation Medicine and Nephrology, Institute of Kidney Diseases & Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
    • ,
  • Rashmi D. Patel

      Affiliations

    • Department of Pathology, Laboratory Medicine and Transfusion Services, Institute of Kidney Diseases & Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
    • Department of Immunohematology, Institute of Kidney Diseases & Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
    • ,
  • Kamal V. Kanodia

      Affiliations

    • Department of Pathology, Laboratory Medicine and Transfusion Services, Institute of Kidney Diseases & Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
    • Department of Immunohematology, Institute of Kidney Diseases & Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
    • ,
  • Javed M. Vakil

      Affiliations

    • Department of Transplantation Medicine and Nephrology, Institute of Kidney Diseases & Research Centre and Institute of Transplantation Sciences, Ahmedabad, India

Article Outline

Background

The most interesting recent development in transplantation immunobiology is the clinical implementation of tolerance induction. We report our experience of megadose hematopoietic stem cell transplantation with non-myeloablative minimum conditioning in renal allograft recipients.

Methods

This was a retrospective, single-center study of 159 renal allograft biopsies from two groups of patients: one group underwent a tolerance induction protocol (TIP) before renal transplantation; the other underwent renal transplantation directly. Biopsies were classified into two subgroups to differentiate between acute and late rejection: 127 biopsies, comprising 64 from patients who underwent a TIP and 63 from controls, performed within 180 days after transplantation; and 32 biopsies, comprising 26 from patients who underwent a TIP and six from controls, performed 180 days after transplantation. All patients received cyclosporine 7 mg/kg/day, tapered to 3 mg/kg/day 3 months after transplantation, and subsequently continued at the latter dosage.

Results

There was markedly less immunologic injury (i.e. generally fewer and milder rejection episodes) evident in biopsies from patients who underwent TIP than in biopsies from controls. Cyclosporine toxicity was considerably greater in patients from the TIP versus control group (82.9% vs 40.6%).

Conclusion

TIP protects renal allografts from immunologic injury and has an unexplained cyclosporine-sparing effect.

Key words:  cyclosporine nephrotoxicity , hematopoietic stem cell transplantation , immunologic injury , renal transplantation , tolerance induction protocol

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References 

  1. Trivedi HL , Shah VR , Shah PR , Darji PI , Sane AS , Vanikar AV , et al.   High dose PBSC associated tolerance in live-related renal allograft recipients . Transplant Proc . 2000;32:2001–2002
  2. Trivedi HL , Shah VR , Shah PR , Sane AS , Vanikar AV , Trivedi VB , et al.   Megadose approach to DBMC infusion-induced allograft hyporesponsiveness in living-related renal allograft recipients . Transplant Proc . 2001;33:71–76
  3. Trivedi HL , Shah VR , Vanikar AV , Gera DN , Shah PR , Trivedi VB , et al.   High-dose peripheral blood stem cell infusion: a strategy to induce donor-specific hyporesponsiveness to allografts in pedia-tric renal transplant recipients . Pediatr Transplant . 2002;6:63–68
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PII: S1561-5413(09)60176-9

doi:10.1016/S1561-5413(09)60176-9

Hong Kong Journal of Nephrology
Volume 7, Issue 1 , Pages 22-26, April 2005

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