Immune tolerance induction through haematopoietic chimerism after kidney donation

A 57-year-old man with end-stage kidney disease from type 2 diabetes was assessed at our specialist unit for a kidney transplant to be donated by his brother. The patient was unsensitised and blood group O; his 59-year-old brother was the same blood type and two-haplotype HLA-matched. Both the patient and his brother were enrolled into our immunological tolerance protocol, which combines a haematopoietic stem-cell transplant with a kidney transplant with the goal of inducing sustained mixed chimerism—a state where the recipient's haematopoietic system has a mixture of both host and donor cells.