BACKGROUND: Infusion of hemopoietic
stem cell from
donors can promote the chimeric formation and induce specific immunologic tolerance in the
allograft recipients. However, the pretreatment for
cell transplantation has great
toxicity to recipients. So
immunosuppressant combined
bone marrow infusion is introduced to anti
graft versus host reaction.
OBJECTIVE: Based on
microchimerism , to study the security and associativity of
chimera formation induced by
kidney -
bone marrow transplantation and immunologic tolerance.DESIGN,
TIME AND
SETTING: The contrast
observation was performed at the department of urinary
surgery , The Third People's
Hospital of Zhengzhou City from January 1998 to December 2005.
PARTICIPANTS: According to ABO/Rh
blood type and HLA matching, 96
female patients with
chronic renal failure and waiting for
kidney transplantation were divided into 2 groups, In the combination group,
patients received
kidney combined
bone marrow transplantation ; the other
uremia patients received the other
kidney of
cadavers were served as
control group . The
donors were 48 healthy
males .
METHODS: Bone marrow of
donors was collected simultaneously with
kidney obtain and preserved with cryoprotectant at -198 ℃ in
nitrogen canister. After
kidney transplantation , large
dose of anti-
human lymphocyte immune globulin were used for 2 weeks, then (0.9-2.5)×10~8/kg mononuclearcell was reinfused.
PCR -SRY was used to identify
donor derived
cell -
chimerism .
Lymphocyte subgroup of recipients was determined by
blood test ; and
interleukin 10 was measured by
enzyme linked immunosorbent assay ; in addition, the mass concentration of
tumor necrosis factor α and
tumor necrosis factor β was detected. MAIN OUTCOME
MEASURES: Chimerism ,
lymphocyte subsets and
cytokines were detected at various
time points following
transplantation . Simultaneously, the
transplantation results and complication status of recipients were observed.
RESULTS: The positive rate of
chimera in the combination group was greater than that of the
control group (P < 0.05). The 3-year follow-up showed that
incidence differences of acute rejection between recipients with positive
chimera and recipients with negative
chimera had significance (13%, 35%, P < 0.05). There was no
graft versus host disease occurred in the combination group.
CONCLUSION: Kidney -
bone marrow transplantation can augment
chimerism in early
postoperative period , and significantly reduce the rate of acute rejection, which is safe and beneficia1to induce specific immunologic tolerance in the renal
allograft recipients.