ESPN 53rd Annual Meeting

ESPN 2021


 
Kidney graft without immunosuppression in an adolescent with Fanconi aplasia
DE SAINT-GILLES DAVID 1 BERTHAUD ROMAIN 1 CHARBIT MARINA 1 AVRAMESCU MARINA 1 DEHOUX LAURENE 1 BOYER OLIVIA 1 DORVAL GUILLAUME 2

1- Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance Publique des Hôpitaux de Paris, Paris, France
2- Service de Génétique Moléculaire, Hôpital Necker, Assistance Publique des Hôpitaux de Paris, Paris, France
 
Abstract:

One of the major issues in organ transplantation is graft immune tolerance. The balance between the risk of acute/chronic rejection and infectious complications generated by immunosuppressive therapy tends to minimize their use. In the rare cases of solid organ transplantation following hematopoietic stem cell transplantation (HSCT) for immune deficiency from the same donor, a natural graft tolerance is theoretically expected..

We report herein the case of a 17-year-old girl who underwent kidney transplantation in our center. She suffered from Fanconi aplasia and received a first HSCT from an unrelated HLA-identical donor at the age of 8 years. The outcome was very poor and she received a second HSCT from her haploidentical mother two months later. This procedure was successful despite numerous infectious complications, and liver and skin graft-versus-host disease. The outcome was favorable with complete maternal chimerism (100%) nine years after HSCT. Unfortunately, she progressed to kidney failure from multifactorial origin requiring peritoneal dialysis. The mother was a candidate for living-donor kidney donation. Since the recipient was 100% chimer with the donor’s bone marrow following HSCT, we decided to perform a living-donor kidney transplant without any induction nor maintenance immunosuppression with the mother’s kidney. The cross-match was negative. The renal transplantation was successful with immediate recovery of graft function and no immediate postoperative complications. Nine months after kidney transplantation, she had normal kidney function (creatinine 60µmol/L, eGFR: 97mL/min/1.73m²) with no medication except for phosphorus supplementation.

To our knowledge, this is the first report of a kidney transplantation after HSCT from the same donor without any immunosuppressive therapy. It demonstrates that this strategy is conceivable when stem cells and kidney are from the same donor with a complete donor chimerism.