医学
抗胸腺细胞球蛋白
免疫抑制
美罗华
阿勒姆图祖马
养生
免疫耐受
内科学
免疫学
肾移植
免疫系统
胃肠病学
移植
抗体
作者
James F. Markmann,Bryna E. Burrell,Jonathan S. Bromberg,Choli Hartono,Dixon B. Kaufman,Andrew M. Possselt,Ali Naji,Nancy D. Bridges,Cynthia Breeden,Sai Kanaparthi,Jorge Pardo,Heather Kopetskie,Kristen Mason,Noha Lim,Sindhu Chandran
标识
DOI:10.1016/j.ajt.2024.03.007
摘要
Abstract
Durable tolerance in kidney transplant recipients remains an important but elusive goal. We hypothesized that adding B cell depletion to T cell depletion would generate an immune milieu post-reconstitution dominated by immature transitional B cells, favoring tolerance. The Immune Tolerance Network ITN039ST RESTARRT was a prospective multicenter pilot study of live donor kidney transplant recipients who received induction with rabbit anti-thymocyte globulin and rituximab, and initiated immunosuppression withdrawal (ISW) at 26 weeks. The primary endpoint was freedom from rejection at 52 weeks post-ISW. Six of ten subjects successfully completed ISW. Of these six subjects, four restarted immunosuppression due to acute rejection or recurrent disease, one remains immunosuppression-free for over 9 years, and one was lost to follow-up after being immunosuppression-free for 42 weeks. There were no cases of patient or graft loss. CD19+ B cell frequencies returned to pre-depletion levels by 26 weeks post-transplant; IgD+CD27- naïve B cells predominated. In contrast, memory cells dominated repopulation of the T cell compartment. A regimen of combined B and T cell depletion did not generate the tolerogenic B cell profile observed in preclinical studies and did not lead to durable tolerance in a majority of kidney transplant recipients. NCT01318915
科研通智能强力驱动
Strongly Powered by AbleSci AI