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Chimerism: A Clinical Guide to Tolerance Induction

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Abstract

Kidney transplantation is now the preferred approach to treat end-stage renal failure. However, graft survival is dependent upon the lifelong use of immunosuppressive drugs, which unfortunately are associated with harmful side effects ranging from kidney damage to shortened life-span. The desire to achieve better long-term outcomes for solid organ transplants has led to the emergence of chimerism-based tolerance. Hematopoietic stem cells from the organ donor are used to modulate the recipient’s immune system to provide long-term, drug-free tolerance to the transplanted organ. Three centers in the United States have conducted chimerism-based clinical trials in kidney transplant recipients and have proven safety, feasibility, and efficacy of the approach. In this chapter, we discuss the mechanisms underlying the establishment of chimerism-based tolerance and review in detail protocols used in clinical trials. This approach to kidney transplant tolerance will likely have significant impact on other solid organ and cellular transplants.

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Author notes

  1. Author contributed equally with all other contributors.Andrea R. Merchak and Anita Chhabra

Authors and Affiliations

  1. Institute for Cellular Therapeutics, University of Louisville, Louisville, KY, USA

    Andrea R. Merchak, Anita Y. Chhabra PhD & Suzanne T. Ildstad MD

  2. Northwestern Medical Group, Northwestern University, Chicago, IL, USA

    Joseph R. Leventhal MD, PhD

  3. Regenerex, LLC, Louisville, KY, USA

    Suzanne T. Ildstad MD

Authors
  1. Andrea R. Merchak
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  2. Anita Y. Chhabra PhD
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  3. Joseph R. Leventhal MD, PhD
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  4. Suzanne T. Ildstad MD
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Corresponding author

Correspondence to Suzanne T. Ildstad MD .

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Editors and Affiliations

  1. Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA

    Nicole L. Draper

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Merchak, A.R., Chhabra, A.Y., Leventhal, J.R., Ildstad, S.T. (2018). Chimerism: A Clinical Guide to Tolerance Induction. In: Draper, N. (eds) Chimerism. Springer, Cham. https://doi.org/10.1007/978-3-319-89866-7_9

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  • DOI: https://doi.org/10.1007/978-3-319-89866-7_9

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