Immunomodulatory Strategies Directed Toward Tolerance of Vascularized Composite Allografts.
Journal Article
Background
Achieving tolerance of vascularized composite allografts (VCAs) would improve the risk-to-benefit ratio in patients who undergo this life-enhancing, though not lifesaving, transplant. Kidney cotransplantation along with a short course of high-dose immunosuppression enables tolerance of heart allografts across a full major histocompatibility complex (MHC) mismatch. In this study, we investigated whether tolerance of VCAs across full MHC disparities could be achieved in animals already tolerant of heart and kidney allografts.Methods
Miniature swine that were tolerant of heart and/or kidney allografts long term underwent transplantation of myocutaneous VCA across the same MHC barrier. Before VCA transplant, group 1 (n = 3) underwent class I-mismatched kidney transplantation; group 2 (n = 3) underwent 2 sequential class I-mismatched kidney transplantations; group 3 (n = 2) underwent haploidentical MHC-mismatched heart/kidney transplantation; and group 4 (n = 2) underwent full MHC-mismatched heart/kidney transplantation.Results
All 3 animals in group 1 and 2 of 3 animals in group 2 showed skin rejection within 85 days; 1 animal in group 2 showed prolonged skin survival longer than 200 days. Animals in groups 3 and 4 showed skin rejection within 30 days and regained in vitro evidence of donor responsiveness.Conclusions
This is the first preclinical study in which hearts, kidneys, and VCAs have been transplanted into the same recipient. Despite VCA rejection, tolerance of heart and kidney allografts was maintained. These results suggest that regulatory tolerance of skin is possible but not generally achieved by the same level of immunomodulation that is capable of inducing tolerance of heart and kidney allografts. Achieving tolerance of skin may require additional immunomodulatory therapies.Full Text
Duke Authors
Cited Authors
- Madariaga, MLL; Shanmugarajah, K; Michel, SG; Villani, V; Muraglia, GML; Torabi, R; Leonard, DA; Randolph, MA; Colvin, RB; Yamada, K; Madsen, JC; Cetrulo, CL; Sachs, DH
Published Date
- August 2015
Published In
Volume / Issue
- 99 / 8
Start / End Page
- 1590 - 1597
PubMed ID
- 25757218
Pubmed Central ID
- 25757218
Electronic International Standard Serial Number (EISSN)
- 1534-6080
International Standard Serial Number (ISSN)
- 0041-1337
Digital Object Identifier (DOI)
- 10.1097/tp.0000000000000681
Language
- eng