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A randomized pilot study of donor stem cell infusion in living-related kidney transplant recipients receiving alemtuzumab.

ABSTRACT: BACKGROUND:Transplant tolerance would remove the need for maintenance immunosuppression while improving survival and quality of life. METHODS:A prospective, randomized pilot study was undertaken to assess the safety and efficacy of donor stem cell infusion (DSCI) in living-related kidney transplant recipients treated with alemtuzumab (C1H) induction and tacrolimus and mycophenolate maintenance with switch to sirolimus and weaning over 2 years. RESULTS:Four patients received DSCI; five patients were controls. Graft failure occurred in two patients in the DSCI arm. Recurrence of glomerular disease occurred in two DSCI recipients, leading to graft loss in one. Biopsy-proven acute rejection episodes occurred in three patients (two in the DSCI vs. one in the control). One DSCI patient, with recurrence, subsequently developed antibody-mediated rejection leading to graft failure. In the remaining two DSCI patients, weaning was attempted but was not successful. All (4 of 4) DSCI patients had biopsy-proven chronic allograft injury and/or recurrence. CONCLUSION:DSCI with C1H induction and a steroid-free maintenance regimen in a small group of patients failed to induce tolerance, with suboptimal patient and graft survival. The results do not justify extension of this particular trial and underscore the importance of patient selection, specifically avoidance of patients with glomerulopathies whose recurrence may obscure potential benefit.

SUBMITTER: Ciancio G

PROVIDER: S-EPMC3818358 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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A randomized pilot study of donor stem cell infusion in living-related kidney transplant recipients receiving alemtuzumab.

Ciancio Gaetano G Sageshima Junichiro J Akpinar Edip E Gaynor Jeffrey J JJ Chen Linda L Zarak Alberto A Hanson Lois L Tueros Lissett L Guerra Giselle G Mattiazzi Adela A Kupin Warren W Roth David D Ricordi Camillo C Burke George W GW

Transplantation 20131101 9

<h4>Background</h4>Transplant tolerance would remove the need for maintenance immunosuppression while improving survival and quality of life.<h4>Methods</h4>A prospective, randomized pilot study was undertaken to assess the safety and efficacy of donor stem cell infusion (DSCI) in living-related kidney transplant recipients treated with alemtuzumab (C1H) induction and tacrolimus and mycophenolate maintenance with switch to sirolimus and weaning over 2 years.<h4>Results</h4>Four patients received ...[more]

PMID: 23903014

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Project description:Socioeconomically deprived individuals with renal disease are less likely to receive a live-donor kidney transplant than less-deprived individuals. This qualitative study aimed to identify reasons for the observed socioeconomic disparity in live-donor kidney transplantation.A qualitative study using face-to-face in-depth semistructured interviews.A UK tertiary renal referral hospital and transplant centre.Purposive sampling was used to select deceased-donor transplant recipients from areas of high socioeconomic deprivation (SED) (19 participants), followed by a low SED comparison group (13 participants), aiming for maximum diversity in terms of age, gender, ethnicity, primary renal disease and previous renal replacement therapy.Participants were interviewed following their routine transplant clinic review. Interviews were digitally audio-recorded and transcribed verbatim. Transcripts were coded using NVivo software and analysed using the constant comparison method described in Grounded Theory.Themes common and distinct to each socioeconomic group emerged. 6 themes appeared to distinguish between individuals from areas of high and low SED. 4 themes were distinct to participants from areas of high SED: (1) Passivity, (2) Disempowerment, (3) Lack of social support and (4) Short-term focus. 2 themes were distinct to the low SED group: (1) Financial concerns and (2) Location of donor.Several of the emerging themes from the high SED individuals relate to an individual's lack of confidence and skill in managing their health and healthcare; themes that are in keeping with low levels of patient activation. Inadequate empowerment of socioeconomically deprived individuals by healthcare practitioners was also described. Financial concerns did not emerge as a barrier from interviews with the high SED group. Interventions aiming to redress the observed socioeconomic inequity should be targeted at both patients and clinical teams to increase empowerment and ensure shared decision-making.

Dataset Information

A randomized pilot study of donor stem cell infusion in living-related kidney transplant recipients receiving alemtuzumab.

Publications

A randomized pilot study of donor stem cell infusion in living-related kidney transplant recipients receiving alemtuzumab.

Similar Datasets

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