Mesenchymal stem cells as induction therapy for kidney transplant

For living-related donor kidney recipients, induction therapy with autologous mesenchymal stem cells (MSCs) can improve transplant outcomes, reports a study in the Journal of the American Medical Association.

The trial included 159 patients who were scheduled for living-related donor kidney transplantation from an ABO-compatible, cross match–negative donor. In a 2:1 ratio, patients were randomly assigned to induction therapy with marrow-derived autologous MSCs or anti–interleukin-2 antibody (basiliximab). Autologous MSCs were given at a concentration of 1 to 2 x 106/kg at the time of kidney reperfusion, repeated at 2 weeks. All patients also received calcineurin inhibitors (CNIs); one-half of the MSC group received CNIs at 80 percent of the standard dose.

At 13 and 30 months, there were no significant differences in patient or graft survival. The 6-month rates of biopsy-confirmed graft rejection were lower in patients receiving autologous MSCs: 7.5 percent with standard-dose CNI and 7.7 percent with low-dose CNI, compared with 21.6 percent in the basiliximab group. Induction therapy with MSCs also led to faster recovery of renal function during the first month after transplant in comparison with control individuals: mean difference 6.2–10.0 mL/min per 1.73 m2. At 1 year, patients in the MSC groups had a significantly lower rate of opportunistic infections: hazard ratio 0.42.

Autologous MSCs are a possible alternative to induction therapy with anti–interleukin-2 antibody, with the potential to lower rejection risk. This open-label trial finds several advantages of MSC induction therapy, including a lower acute rejection rate, more rapid return of kidney function, and a lower rate of opportunistic infections. Long-term follow-up studies are planned [Tan J, et al. Induction therapy with autologous mesenchymal stem cells in living-related kidney transplants: a randomized controlled trial. JAMA 2012; 307:1169–1177].

May 2012 (Vol. 4, Number 5)​