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Tolerance Induction after Kidney Transplantation

Tolerance Induction after Kidney Transplantation. Stephan Busque MD M Sc FRCSC Director, Adult Kidney and Pancreas Transplantation Program Stanford University. Stanford Kidney Transplant Program 1991-2004 (n=726). Immunosuppression Medication Side-effects. Infection Cancer Diabetes

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Tolerance Induction after Kidney Transplantation

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  1. Tolerance Induction after Kidney Transplantation Stephan Busque MD M Sc FRCSC Director, Adult Kidney and Pancreas Transplantation Program Stanford University

  2. Stanford Kidney Transplant Program 1991-2004 (n=726)

  3. Immunosuppression Medication Side-effects • Infection • Cancer • Diabetes • Cosmetic • NEPHROTOXICITY

  4. HLA-matched Combined Kidney/Hematopoietic Cell Transplantation Protocol rATG (1.5 mg/kg) TLI Donor CD34+ cell infusion Inclusion of CD3+ cells (dose 1 x 106/kg) Day 0 Kidney Transplant Prednisonex 10 days only d/c day 30 MMF Cyclosporine wean month 3-6 Withdraw immunosuppression if: -stable macrochimerism -no evidence of rejection -no GVHD

  5. Subject Characteristics 12/06

  6. ChimerismSubject # 1 12/06

  7. 300 250 Patient#1 Patient#3 200 150 100 MMF 50 0 0 30 60 90 120 150 180 Drug Taper CSA mg/day Days After Transplantation

  8. Allograft Function Subject # 1 Immunosuppression stopped 12/06

  9. ChimerismSubject # 2 12/06

  10. Allograft FunctionSubject # 2 12/06

  11. ChimerismSubject # 3 12/06

  12. Allograft FunctionSubject # 3 12/06

  13. Clinical Outcome – Current Status 12/06

  14. Tolerance project:New directions • Increase dose of radiation from 100 to 120 cG • Increasing T-cell dose and/or CD 34 • Expand to: • Non matched donor-recipient pair • Liver transplantation

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