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Abstract: SA-PO850

Immune Tolerance in a Kidney Transplant Recipient With Two Related Donors

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Memon, Aliza Anwar, Saint Louis University, Saint Louis, Missouri, United States
  • Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
  • Vo, Thanh-Mai Nguyen, Saint Louis University, Saint Louis, Missouri, United States
  • Abu Al Rub, Fadee, Saint Louis University, Saint Louis, Missouri, United States
  • Bastani, Bahar, Saint Louis University, Saint Louis, Missouri, United States
  • Edwards, John C., Saint Louis University, Saint Louis, Missouri, United States
  • Caliskan, Yasar, Saint Louis University, Saint Louis, Missouri, United States
Introduction

Immune tolerance is multifaceted and involves the interaction of different cells. Despite major advances, widespread tolerance in solid organ transplantation has not yet been achieved without dependence on immunosuppressive treatment. Compulsory exposure to genetically foreign maternal tissue imprints in offspring sustained tolerance to noninherited maternal antigens (NIMA). Here, we describe a case of successful second transplant with persistence immune tolerance more than 20 years.

Case Description

A 53-year-old man with second living donor kidney transplant from his sister was consulted with Transplant Nephrology Unit. Patient had a past medical history of end stage kidney disease due to bilateral vesicoureteral reflux nephropathy, status post failed living donor kidney transplant from his mother in 1981 until 1984, first allograft nephrectomy, status post hemodialysis between 1984-1988 and status post second living donor kidney transplant from his sister in 1988. Patient’s first kidney transplant failed due to rejection after 3 years. The patient received second transplant from his sister in June 1988. Patient discontinued his immunosuppressive treatment in 1999. Since then his serum creatinine level ranged between 1-1.2 mg/dL without any immunosuppressive treatment. Laboratory tests revealed: serum BUN 14 mg/dL, creatinine 1.13 mg/dL, total protein 7 g/dL, albumin 4.2 g/dL. Urine sediment showed 0-2 red blood and 0-5 white blood cells per high power field. Urine analysis showed no proteinuria. The Luminex single antigen bead HLA antibody screening test showed panel reactive antibody level of 0% and 8% for class I and II antibodies. The weak class II antibodies were against HLA-DQ:06:01, DQ:05:01, DQ:05:03, DQ:06:03, DQ:06:04 and DQ:06:02. Previous donors’ HLA DQ typing were not available. Patient continued his posttransplant follow up without any immunosuppressive treatment.

Discussion

Although the exact mechanism of tolerance to second kidney transplant in this case is not known, transplantation of a kidney from his mother exposes the patient to the other haplotype carrying the NIMAs and this exposure of the fetus to NIMAs can lead to tolerance because of immaturity of the fetal immune system. This case highlights an important model to study further the NIMA-specific tolerance and the underlying mechanisms.