RENAL TRANSPLANTATION FOR ESRD FOLLOWING BONE MARROW TRANSPLANTATION: A REPORT OF 5 CASES, WITH AND WITHOUT IMMUNOSUPPRESSION

Abstract

657 Over 12,000 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 is usually secondary to radiation and/or CsA toxicity. Survival on dialysis therapy for patients with radiation nephropathy is poor (Cohen, et al, JASN, 1997 (8); 135A) and renal transplantation may be a preferable form of renal replacement therapy. This report summarizes our experience with renal transplantation in 5 patients with ESRD (three due to radiation nephropathy; one secondary to TTP/HUS; and one due to anti-tubular basement membrane nephritis) following BMT. All five patients were Caucasian, with 4 females and 1 male included in this study. Their ages at the time of renal transplant ranged from 27-40 years. BMT was performed for chronic myelogenous leukemia in 2 patients, acute myelogenous leukemia in 2, and acute lymphocytic leukemia in 1. ESRD developed after a mean of 100 months (range 84-132 months) post-BMT and 4 of the 5 patients were maintained on dialysis for a mean of 11 months (range 1-13 months) prior to renal transplantation. The kidney source was from an LRD in 4 patients, and CAD in one patient. In two recipients, the bone marrow and kidneys were from the same donor. One of these recipients is managed without any immunosuppressive therapy and the other is maintained on azathioprine (25 mg/day) alone. The other three are maintained on triple therapy (prednisone, MMF/azathioprine, and CsA/FK506). Immediately post-transplant, one patient had a ureteral leak, and one patient had acute rejection, treated with OKT3. In all five patients renal function stabilized after transplantation. One patient experienced urosepsis two months after renal transplantation, which responded to treatment. These patients have been followed for up to 22 months (range 2-22 months) post-transplant and all are alive with functioning bone marrow and renal allografts. Their creatinines range from 0.8 to 2.1 mg/dl (mean 1.2 mg/dl). In summary: 1) Renal transplant is a feasible alternative for patients with ESRD following BMT; 2) If bone marrow and kidney are from the same donor, the recipient requires little or no maintenance immunosuppression; 3) Short-term results show good survival, but long-term follow-up is needed.