Akihiro Tsuchimoto1, Kosuke Masutani2, Kazuya Omoto3, Masayoshi Okumi3, Yasuhiro Okabe4, Takehiro Nishiki5, Morihito Ota6, Toshiaki Nakano1, Kazuhiko Tsuruya1, Takanari Kitazono1, Masafumi Nakamura4, Hideki Ishida3, Kazunari Tanabe7. 1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2. Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 3. Department of Urology, Tokyo Women's Medical University, 8-1 Kawata-machi, Shinjuku-ku, Tokyo, 162-8666, Japan. 4. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 5. Department of Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan. 6. Department of Surgery, Tomishiro Central Hospital, Okinawa, Japan. 7. Department of Urology, Tokyo Women's Medical University, 8-1 Kawata-machi, Shinjuku-ku, Tokyo, 162-8666, Japan. tanabe@twmu.ac.jp.
Abstract
BACKGROUND: The safety of kidney transplantation (KT) for end-stage kidney disease (ESKD) after haematopoietic stem cell transplantation (HSCT) for haematological disease has not been investigated thoroughly. METHODS: In this retrospective multicentre study, we investigated the clinical courses of six ESKD patients that received KT after HSCT for various haematological diseases. Data for six such patients were obtained from three institutions in our consortium. RESULTS: Two patients with chronic myeloid leukaemia, one with refractory aplastic anaemia and another one with acute lymphocytic leukaemia received bone marrow transplantation. One patients with acute lymphocytic leukaemia received umbilical cord blood transplantation, and one with mantle cell lymphoma received peripheral blood stem cell transplantation. The patients developed ESKD at a median of 133 months after HSCT. Two patients who received KT and HSCT from the same donor were temporarily treated with immunosuppressive drugs. The other patients received KT and HSCT from different donors and were treated with antibody induction using our standard regimens. For one patient with ABO-incompatible transplantation, we added rituximab, splenectomy, and plasmapheresis. In the observational period at a median of 51 months after KT, only one patient experienced acute T-cell-mediated rejection. Four patients underwent hospitalization because of infection and fully recovered. No patient experienced recurrence of their original haematological disease. All patients survived throughout the observational periods, and graft functions were preserved. CONCLUSIONS: Despite the high infection frequency, survival rates and graft functions were extremely good in patients compared with previous studies. Therefore, current management contributed to favourable outcomes of these patients.
BACKGROUND: The safety of kidney transplantation (KT) for end-stage kidney disease (ESKD) after haematopoietic stem cell transplantation (HSCT) for haematological disease has not been investigated thoroughly. METHODS: In this retrospective multicentre study, we investigated the clinical courses of six ESKD patients that received KT after HSCT for various haematological diseases. Data for six such patients were obtained from three institutions in our consortium. RESULTS: Two patients with chronic myeloid leukaemia, one with refractory aplastic anaemia and another one with acute lymphocytic leukaemia received bone marrow transplantation. One patients with acute lymphocytic leukaemia received umbilical cord blood transplantation, and one with mantle cell lymphoma received peripheral blood stem cell transplantation. The patients developed ESKD at a median of 133 months after HSCT. Two patients who received KT and HSCT from the same donor were temporarily treated with immunosuppressive drugs. The other patients received KT and HSCT from different donors and were treated with antibody induction using our standard regimens. For one patient with ABO-incompatible transplantation, we added rituximab, splenectomy, and plasmapheresis. In the observational period at a median of 51 months after KT, only one patient experienced acute T-cell-mediated rejection. Four patients underwent hospitalization because of infection and fully recovered. No patient experienced recurrence of their original haematological disease. All patients survived throughout the observational periods, and graft functions were preserved. CONCLUSIONS: Despite the high infection frequency, survival rates and graft functions were extremely good in patients compared with previous studies. Therefore, current management contributed to favourable outcomes of these patients.
Entities:
Keywords:
Bone marrow transplantation; GVHD; Infection; Leukemia; Malignancy; Rejection
Authors: Joana E Kist-van Holthe; Charlotte A Goedvolk; Ronald Brand; Margreet H van Weel; Robbert G M Bredius; Jacques A van Oostayen; Jacques M J J Vossen; Bert J van der Heijden Journal: Pediatr Nephrol Date: 2002-11-14 Impact factor: 3.714