Researchers investigated the outcome of renal transplant patients given donor bone marrow infusions, and reported their findings in Transplantation.
63 cadaver (CAD) renal transplant recipients of either one or two postoperative donor bone marrow cell (DBMC) infusions were prospectively compared with 219 non-infused controls given equivalent immunosuppression.
The immunosuppressive regimen included a 10-day course of OKT3 induction, and tacrolimus, mycophenolate mofetil, and methylprednisolone maintenance.
Clinical follow-up ranged from 2.9 to 6.3 years (mean, 4.7 years).
|Graft survival at 6.3 years, excluding deaths:|
DBMC group: 94%
The researchers also performed studies of humoral immunity and quantitative cellular chimerism.
There was a clear-cut equivalence in immunosuppressive dosaging and in the other major demographic variables in both groups.
It was found that only 2/63 DBMC recipients had biopsy-proven chronic rejection, whereas 41/219 controls showed chronic rejection.
Mortality was not associated with rejection in either group.
The actuarial graft survival at 6.3 years in the CAD DBMC group was 84%, compared with 72% in the control group. This was not statistically significant.
However, when death with a functioning graft was excluded, graft survival was 94% in the DBMC group and 80% in the controls, and was significant.
40 patients in the control group continued to have deteriorating renal function, compared with 2 patients in the DBMC group.
In the DBMC group, chimerism in iliac crest marrow aspirates increased 3-fold in yearly sequential measurements between 1 and 4 years postoperatively, averaging 1.3 years. This did not occur in the controls.
Author Gaetano Ciancio said on behalf of colleagues, "Now there appears to be more solid long-term evidence, in kidney transplant recipients prospectively receiving DBMC infusions, of an improvement in long-term graft survival.
"There is also more evidence of the degree of chimerism positively correlating with the absence of graft loss."