Operational tolerance in intestinal transplantation.
T cell biology
cellular biology
clinical research/practice
immune regulation
immunosuppression/immune modulation
intestinal (allograft) function/dysfunction
intestine/multivisceral transplantation
mucosal immunity
tolerance
translational research/science
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
10
01
2020
revised:
29
06
2020
accepted:
15
07
2020
pubmed:
29
7
2020
medline:
22
6
2021
entrez:
29
7
2020
Statut:
ppublish
Résumé
By presenting the first case report of true operational tolerance in an intestinal transplant patient, we aim to demonstrate that tolerance is possible in a field that has been hampered by suboptimal outcomes. Although operational tolerance has been achieved in liver and kidney transplantation, and some intestinal transplant patients have been able to decrease immunosuppression, this is the first instance of true operational tolerance after complete cessation of immunosuppression. A patient received a deceased-donor small intestinal and colon allograft with standard immunosuppressive treatment, achieving excellent graft function after overcoming a graft-versus-host-disease episode 5 months posttransplant. Four years later, against medical advice, the patient discontinued all immunosuppression. During follow-up visits 2 and 3 years after cessation of immunosuppression, the patient exhibited normal graft function with full enteral autonomy and without histological or endoscopic signs of rejection. Mechanistic analysis demonstrated immune competence against third party antigen, with in vitro evidence of donor-specific hyporesponsiveness in the absence of donor macrochimerism. This proof of principle case can stimulate future mechanistic studies on diagnostic and therapeutic strategies, for example, cellular therapy trials, that can lead to minimization or elimination of immunosuppression and, it is hoped, help revitalize the field of intestinal transplantation.
Identifiants
pubmed: 32721092
doi: 10.1111/ajt.16224
pmc: PMC8274367
mid: NIHMS1681430
pii: S1600-6135(22)08412-X
doi:
Substances chimiques
Immunosuppressive Agents
0
Types de publication
Case Reports
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
876-882Subventions
Organisme : NIAID NIH HHS
ID : R01 AI132389
Pays : United States
Informations de copyright
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.
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