Combined simultaneous kidney/bone marrow transplantation

Ron Shapiro, Abdul S. Rao, Paulo Fontes, Adrianna Zeevi, Mark Jordan, Velma P. Scantlebury, Carlos Vivas, H. Albin Gritsch, Robert J. Corry, Francesca Egidi, Maria T. Rugeles, Horacio Rilo, Abdelouahab Aitouche, Anthony J. Demetris, Gayle Rosner, Massimo Trucco, Witold Rybka, William Irish, John J. Fung, Thomas E. Starzl

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Abstract

On the basis of observations in patients with longterm (28-30 years) renal allograft survival, all of whom had evidence of systemic microchimerism, we began a program of combined simultaneous kidney/bone marrow transplantation. Between 12/14/92, and 10/31/94,36 kidney transplant recipients received 3-5 x 108 unmodified bone marrow cells/kg; 6 patients also received pancreatic islets, and 7 patients also received a pancreas. The mean recipient age was 39.0 ±10.8 years, and the mean donor age was 31.8 ±16.1 years; the mean cold ischemia time was 23.0±9.1 hr. Twenty control patients received kidneys alone, mainly because of refusal by the donor family to consent to vertebral body recovery; 3 of these patients also received a pancreas. The mean recipient age was 47.9 ±11.7 years, and the mean donor age was 41.5 ±17.9 years; the mean cold ischemia time was 28.6 ±6.2 hr. All patients received tacrolimus-based therapy, without radiation, cytoreduction, or induction antilymphocyte preparations. Blood was drawn prior to and at regular intervals after transplantation for detection of chimerism and for immunologic studies. With a mean follow-up of 11.1 ±5.8 months, all 36 study patients are alive, and 33 (92%) have functioning allografts with a mean serum creatinine of 1.9±1.2 mg/dl and a BUN of 26±9 mg/dl. Graft vs. host disease was not seen in any patient. The incidence of rejection was 72%; 11% of the patients required OKT3 or ATG for steroid-resistant rejection. The incidence of CMV was 14%, and that of delayed graft function was 17%. A total of 18 (90%) control patients are alive, and 17 (85%) have functioning allografts, with a mean serum creatinine of 2.1 ±1.3 mg/ dl, and a BUN of 30±13 mg/dl. The incidence of rejection was 60%, and 10% required OKT3 or ATG. CMV was seen in 15%, and delayed graft function in 20% (P=NS). In the study patients, chimerism was detected in the peripheral blood of 30 of 31 (97%) evaluable patients by either PCR or flow cytometry. In the control patients, chimerism was seen in 9 of 14 (64%) evaluable patients (P<.02). Decreasing donor-specific responsiveness was seen in 6/29 (21%) evaluable study, and 4/14 (29%) evaluable control patients (P=NS). We conclude that combined kidney/bone marrow transplantation is associated with acceptable patient and graft survival, augmentation of chimerism, and no change in the early events after transplantation.

Original languageEnglish (US)
Pages (from-to)1421-1425
Number of pages5
JournalTransplantation
Volume60
Issue number12
DOIs
StatePublished - Dec 27 1995

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Bone Marrow Transplantation
Kidney
Chimerism
Tissue Donors
Delayed Graft Function
Allografts
Cold Ischemia
Muromonab-CD3
Blood Urea Nitrogen
Pancreas
Creatinine
Incidence
Transplantation
Tacrolimus
Graft Survival
Serum
Islets of Langerhans
Bone Marrow Cells
Flow Cytometry

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Shapiro, R., Rao, A. S., Fontes, P., Zeevi, A., Jordan, M., Scantlebury, V. P., ... Starzl, T. E. (1995). Combined simultaneous kidney/bone marrow transplantation. Transplantation, 60(12), 1421-1425. https://doi.org/10.1097/00007890-199560120-00009
Shapiro, Ron ; Rao, Abdul S. ; Fontes, Paulo ; Zeevi, Adrianna ; Jordan, Mark ; Scantlebury, Velma P. ; Vivas, Carlos ; Gritsch, H. Albin ; Corry, Robert J. ; Egidi, Francesca ; Rugeles, Maria T. ; Rilo, Horacio ; Aitouche, Abdelouahab ; Demetris, Anthony J. ; Rosner, Gayle ; Trucco, Massimo ; Rybka, Witold ; Irish, William ; Fung, John J. ; Starzl, Thomas E. / Combined simultaneous kidney/bone marrow transplantation. In: Transplantation. 1995 ; Vol. 60, No. 12. pp. 1421-1425.
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abstract = "On the basis of observations in patients with longterm (28-30 years) renal allograft survival, all of whom had evidence of systemic microchimerism, we began a program of combined simultaneous kidney/bone marrow transplantation. Between 12/14/92, and 10/31/94,36 kidney transplant recipients received 3-5 x 108 unmodified bone marrow cells/kg; 6 patients also received pancreatic islets, and 7 patients also received a pancreas. The mean recipient age was 39.0 ±10.8 years, and the mean donor age was 31.8 ±16.1 years; the mean cold ischemia time was 23.0±9.1 hr. Twenty control patients received kidneys alone, mainly because of refusal by the donor family to consent to vertebral body recovery; 3 of these patients also received a pancreas. The mean recipient age was 47.9 ±11.7 years, and the mean donor age was 41.5 ±17.9 years; the mean cold ischemia time was 28.6 ±6.2 hr. All patients received tacrolimus-based therapy, without radiation, cytoreduction, or induction antilymphocyte preparations. Blood was drawn prior to and at regular intervals after transplantation for detection of chimerism and for immunologic studies. With a mean follow-up of 11.1 ±5.8 months, all 36 study patients are alive, and 33 (92{\%}) have functioning allografts with a mean serum creatinine of 1.9±1.2 mg/dl and a BUN of 26±9 mg/dl. Graft vs. host disease was not seen in any patient. The incidence of rejection was 72{\%}; 11{\%} of the patients required OKT3 or ATG for steroid-resistant rejection. The incidence of CMV was 14{\%}, and that of delayed graft function was 17{\%}. A total of 18 (90{\%}) control patients are alive, and 17 (85{\%}) have functioning allografts, with a mean serum creatinine of 2.1 ±1.3 mg/ dl, and a BUN of 30±13 mg/dl. The incidence of rejection was 60{\%}, and 10{\%} required OKT3 or ATG. CMV was seen in 15{\%}, and delayed graft function in 20{\%} (P=NS). In the study patients, chimerism was detected in the peripheral blood of 30 of 31 (97{\%}) evaluable patients by either PCR or flow cytometry. In the control patients, chimerism was seen in 9 of 14 (64{\%}) evaluable patients (P<.02). Decreasing donor-specific responsiveness was seen in 6/29 (21{\%}) evaluable study, and 4/14 (29{\%}) evaluable control patients (P=NS). We conclude that combined kidney/bone marrow transplantation is associated with acceptable patient and graft survival, augmentation of chimerism, and no change in the early events after transplantation.",
author = "Ron Shapiro and Rao, {Abdul S.} and Paulo Fontes and Adrianna Zeevi and Mark Jordan and Scantlebury, {Velma P.} and Carlos Vivas and Gritsch, {H. Albin} and Corry, {Robert J.} and Francesca Egidi and Rugeles, {Maria T.} and Horacio Rilo and Abdelouahab Aitouche and Demetris, {Anthony J.} and Gayle Rosner and Massimo Trucco and Witold Rybka and William Irish and Fung, {John J.} and Starzl, {Thomas E.}",
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Shapiro, R, Rao, AS, Fontes, P, Zeevi, A, Jordan, M, Scantlebury, VP, Vivas, C, Gritsch, HA, Corry, RJ, Egidi, F, Rugeles, MT, Rilo, H, Aitouche, A, Demetris, AJ, Rosner, G, Trucco, M, Rybka, W, Irish, W, Fung, JJ & Starzl, TE 1995, 'Combined simultaneous kidney/bone marrow transplantation', Transplantation, vol. 60, no. 12, pp. 1421-1425. https://doi.org/10.1097/00007890-199560120-00009

Combined simultaneous kidney/bone marrow transplantation. / Shapiro, Ron; Rao, Abdul S.; Fontes, Paulo; Zeevi, Adrianna; Jordan, Mark; Scantlebury, Velma P.; Vivas, Carlos; Gritsch, H. Albin; Corry, Robert J.; Egidi, Francesca; Rugeles, Maria T.; Rilo, Horacio; Aitouche, Abdelouahab; Demetris, Anthony J.; Rosner, Gayle; Trucco, Massimo; Rybka, Witold; Irish, William; Fung, John J.; Starzl, Thomas E.

In: Transplantation, Vol. 60, No. 12, 27.12.1995, p. 1421-1425.

Research output: Contribution to journalArticle

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T1 - Combined simultaneous kidney/bone marrow transplantation

AU - Shapiro, Ron

AU - Rao, Abdul S.

AU - Fontes, Paulo

AU - Zeevi, Adrianna

AU - Jordan, Mark

AU - Scantlebury, Velma P.

AU - Vivas, Carlos

AU - Gritsch, H. Albin

AU - Corry, Robert J.

AU - Egidi, Francesca

AU - Rugeles, Maria T.

AU - Rilo, Horacio

AU - Aitouche, Abdelouahab

AU - Demetris, Anthony J.

AU - Rosner, Gayle

AU - Trucco, Massimo

AU - Rybka, Witold

AU - Irish, William

AU - Fung, John J.

AU - Starzl, Thomas E.

PY - 1995/12/27

Y1 - 1995/12/27

N2 - On the basis of observations in patients with longterm (28-30 years) renal allograft survival, all of whom had evidence of systemic microchimerism, we began a program of combined simultaneous kidney/bone marrow transplantation. Between 12/14/92, and 10/31/94,36 kidney transplant recipients received 3-5 x 108 unmodified bone marrow cells/kg; 6 patients also received pancreatic islets, and 7 patients also received a pancreas. The mean recipient age was 39.0 ±10.8 years, and the mean donor age was 31.8 ±16.1 years; the mean cold ischemia time was 23.0±9.1 hr. Twenty control patients received kidneys alone, mainly because of refusal by the donor family to consent to vertebral body recovery; 3 of these patients also received a pancreas. The mean recipient age was 47.9 ±11.7 years, and the mean donor age was 41.5 ±17.9 years; the mean cold ischemia time was 28.6 ±6.2 hr. All patients received tacrolimus-based therapy, without radiation, cytoreduction, or induction antilymphocyte preparations. Blood was drawn prior to and at regular intervals after transplantation for detection of chimerism and for immunologic studies. With a mean follow-up of 11.1 ±5.8 months, all 36 study patients are alive, and 33 (92%) have functioning allografts with a mean serum creatinine of 1.9±1.2 mg/dl and a BUN of 26±9 mg/dl. Graft vs. host disease was not seen in any patient. The incidence of rejection was 72%; 11% of the patients required OKT3 or ATG for steroid-resistant rejection. The incidence of CMV was 14%, and that of delayed graft function was 17%. A total of 18 (90%) control patients are alive, and 17 (85%) have functioning allografts, with a mean serum creatinine of 2.1 ±1.3 mg/ dl, and a BUN of 30±13 mg/dl. The incidence of rejection was 60%, and 10% required OKT3 or ATG. CMV was seen in 15%, and delayed graft function in 20% (P=NS). In the study patients, chimerism was detected in the peripheral blood of 30 of 31 (97%) evaluable patients by either PCR or flow cytometry. In the control patients, chimerism was seen in 9 of 14 (64%) evaluable patients (P<.02). Decreasing donor-specific responsiveness was seen in 6/29 (21%) evaluable study, and 4/14 (29%) evaluable control patients (P=NS). We conclude that combined kidney/bone marrow transplantation is associated with acceptable patient and graft survival, augmentation of chimerism, and no change in the early events after transplantation.

AB - On the basis of observations in patients with longterm (28-30 years) renal allograft survival, all of whom had evidence of systemic microchimerism, we began a program of combined simultaneous kidney/bone marrow transplantation. Between 12/14/92, and 10/31/94,36 kidney transplant recipients received 3-5 x 108 unmodified bone marrow cells/kg; 6 patients also received pancreatic islets, and 7 patients also received a pancreas. The mean recipient age was 39.0 ±10.8 years, and the mean donor age was 31.8 ±16.1 years; the mean cold ischemia time was 23.0±9.1 hr. Twenty control patients received kidneys alone, mainly because of refusal by the donor family to consent to vertebral body recovery; 3 of these patients also received a pancreas. The mean recipient age was 47.9 ±11.7 years, and the mean donor age was 41.5 ±17.9 years; the mean cold ischemia time was 28.6 ±6.2 hr. All patients received tacrolimus-based therapy, without radiation, cytoreduction, or induction antilymphocyte preparations. Blood was drawn prior to and at regular intervals after transplantation for detection of chimerism and for immunologic studies. With a mean follow-up of 11.1 ±5.8 months, all 36 study patients are alive, and 33 (92%) have functioning allografts with a mean serum creatinine of 1.9±1.2 mg/dl and a BUN of 26±9 mg/dl. Graft vs. host disease was not seen in any patient. The incidence of rejection was 72%; 11% of the patients required OKT3 or ATG for steroid-resistant rejection. The incidence of CMV was 14%, and that of delayed graft function was 17%. A total of 18 (90%) control patients are alive, and 17 (85%) have functioning allografts, with a mean serum creatinine of 2.1 ±1.3 mg/ dl, and a BUN of 30±13 mg/dl. The incidence of rejection was 60%, and 10% required OKT3 or ATG. CMV was seen in 15%, and delayed graft function in 20% (P=NS). In the study patients, chimerism was detected in the peripheral blood of 30 of 31 (97%) evaluable patients by either PCR or flow cytometry. In the control patients, chimerism was seen in 9 of 14 (64%) evaluable patients (P<.02). Decreasing donor-specific responsiveness was seen in 6/29 (21%) evaluable study, and 4/14 (29%) evaluable control patients (P=NS). We conclude that combined kidney/bone marrow transplantation is associated with acceptable patient and graft survival, augmentation of chimerism, and no change in the early events after transplantation.

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Shapiro R, Rao AS, Fontes P, Zeevi A, Jordan M, Scantlebury VP et al. Combined simultaneous kidney/bone marrow transplantation. Transplantation. 1995 Dec 27;60(12):1421-1425. https://doi.org/10.1097/00007890-199560120-00009