Renal transplantation for end-stage renal disease following bone marrow transplantation: A report of six cases, with and without immunosuppression

Background. Over 12000 bone marrow transplantations (BMT) are performed in the USA each year. This procedure is associated with significant morbidity including acute and chronic renal failure (CRF). CRF after BMT is usually s econdary to radiation nephropathy and:or cyclosporine (CsA) toxicity. Survi val on dialysis therapy for patients with radiation nephropathy is poor and renal transplantation may be a preferable form of renal-replacement therap y. Methods. We report our experience with renal transplantation in 6 patients with end-stage renal disease (ESRD) following BMT: 4 as a result of radiati on nephropathy; one secondary to hemolytic-uremic syndrome; and 1 as a resu lt of antitubular basement membrane nephritis. Ages at the time of BMT rang ed from 16 to 40 yr. ESRD developed after a mean period of 94 months (range 42 140 months) after BMT. The kidney source was from a living donor in 5 p atients, and a cadaveric donor (CAD) in 1 patient. In 3 recipients, the bon e marrow and kidney were from the same donor. They are managed without any immunosuppressive therapy. The other 3 were initialed on triple therapy (pr ednisone, mycophenolate mofetil/azathioprine and cyclosporine/tacrolimus). Results, These patients have been followed for up to 31 months (range 3-30 months) after kidney transplant, and 5 out of 6 are alive with functioning bone marrow and renal transplants. Their plasma creatinines range fi om 70 to 160 mu mol/L (mean 97 mu mol/L). One patient died following metastatic s quamous cell cancer of the genital tract. Conclusions. 1) Renal transplant is a feasible alternative for patients wit h ESRD following BMT: 2) if bone marrow and kidney are from the same donor, the recipient requires little or no maintenance immunosuppression: 3) shor t-term results show good survival, but longterm follow-up is needed; 3) inf ections and malignancy post-renal transplantation were seen in recipients w ho needed immunosuppression; and 5) reduction in immunosuppression may be n eeded in such post-BMT patients who undergo kidney transplants.