Unexplained post-renal transplant tolerance: a case report
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BRIEF REPORT
Unexplained post-renal transplant tolerance: a case report Sailaja Kesiraju1 • Uma Maheswara Rao Ch2 • Purna Paritala3 • Sreedhar Reddy3 V. S. Reddy3 • S. Sahariah1,2,3
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Ó Springer Science+Business Media New York 2015
Abstract Achievement of an immunosuppression-free condition defined as clinical operational tolerance is an ideal goal. We hereby report a case of clinical operational tolerance in a patient whose allograft is functioning normally, without immunosuppression, for more than 3 years. The patient withdrew from immunosuppression in 2011 following which his serum creatinine was 1.34 mg/dl and proteinuria was 178 mg/24 h. Flowcytometric studies showed an elevated number of B lymphocytes and NK cells. IL-10 cytokine levels had increased, whereas those of IFN-c decreased, suggesting that both B lymphocytes and NK cells, with their immunoregulatory function, contribute to the maintenance of long-term graft function. Consequently, further studies in understanding the interactions of NK cells and B lymphocytes may give us a better insight into the underlying mechanisms that underpin organ tolerance. Keywords Tolerance NK cell B lymphocyte Renal transplant Immunosuppression Abbreviations NK Natural killer cell TNF-a Tumor necrosis factor alpha
& Sailaja Kesiraju [email protected] 1
Department of Immunology and Biochemistry, TransimmunTransplantation Immunology and Research Center, Somajiguda, Hyderabad 500082, India
2
Kidney Transplant Unit, Mahavir Hospital and Research Center, AC Guards, Hyderabad, India
3
Department of Nephrology and Transplantation, Krishna Institute of Medical Sciences, Hyderabad, India
TGF-b IFN-c IL-10
Transforming growth factor beta Interferon gamma Interleukin-10
Introduction Organ transplantation requires prolonged immunosuppression for allograft survival which causes complications and compromise in the long-term outcome. Transplant biologists across the world have been developing new strategies to harness the mechanisms involved in immune tolerance to improve the outcome of transplant. Encouraging results have emerged from many experimental models, but implementing these protocols in humans is a difficult task. The underlying mechanisms are complex, and we still do not understand how, why and when the human immune system can accept the allograft. Experimental allograft tolerance is now commonly achieved in rodents and has been demonstrated in higher animals, including pigs [1, 2], dogs [3, 4] and primates [5, 6]. Indeed, in humans, tolerance to transplanted allograft has been reported, although its occurrence remains uncommon and unpredictable. Many of these so-called patients with tolerance in fact are detected when they report to the treating physician with normal graft function but without taking any immunosuppressive medication. Achieving long-term, drug-free graft acceptance with normal organ function is our ideal goal. We are reporting a case of clinical operational tolerance from India for the first time, to the best of our knowledge. A
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