Co-infusion of donor adipose tissue-derived mesenchymal and hematopoietic stem cells helps safe minimization of immunosuppression in renal transplantation – single center experience

Figures & data

Figure 1. (a) Tolerance induction protocol for group-1. (b) Tolerance induction protocol for group-2.

Table 1. Patient–donor demographics of the three groups subjected to renal transplantation.

Group	Group-1 (AD-MSC +HSC) (n = 95)	Group-2 (HSC) (n = 95)	Group-3 (No SCT) (n = 95)	p Value
Mean age (years ± SD) (range)	31.3 ± 10.8	31.6 ± 10.9	35 ± 12.2	0.044
Gender: M:F	76: 19	89: 6	71: 24	0.002
Original disease
Chronic glomerulonephritis	50	44	40	0.343
Chronic tubulointerstitial nephritis	08	10	10	0.853
Diabetic nephropathy	03	07	04	0.377
Others	38	38	45	0.495
Mean donor age (years ± SD) (range)	47 ± 11.5	48.4 ± 9.2	46.4 ± 10.8	0.304
Donor Gender: M:F	38: 57	27: 68	29: 66	0.195
Relationship
Parents	57	60	40	0.007
Spousal	15	12	21	0.206
Siblings	10	12	15	0.554
Others	13	11	19	0.241
Donor–recipient HLA match	2.7 ± 1.1	2.6 ± 1.3	2.7 ± 1.4	0.819
Mean HSC infused (n × 10^8 cells/kg BW)	8.85 ± 3.97	10.42 ± 5.98	0	0.036
Mean CD34^+ (n × 10^6 cells/kg BW)	1.23 ± 0.62	1.80 ± 1.19	0	0.0003
Mean H-AD- MSC infused (n × 10^4 cells/kg BW)	0.33 ± 0.27	0	0

Table 2. Follow-up of the three groups subjected to renal transplantation.

Group	Group-1 (AD-MSC +HSC) (n = 95)	Group-2 (HSC) (n = 95)	Group-3 (No SCT) (n = 95)	p Value
Mean follow-up (years ± SD)	6 ± 0.2	6.96 ± 0.45	4.25 ± 1.18	< 0.0001
Patient survival	88/95	88/95	82/95	0.003
1 year	100%	100%	94.7%	–
3 years	100%	97.9%	90.5%	–
5 years	94.7%	95.7%	84%	–
7 years	Not appeared	92.5%	78.4%	–
Death due to infections	1/7	2/7	9/13	0.038
Death due to other causes	6/7	5/7	4/13	0.038
Graft survival	89/95	83/95	90/95	0.245
1 year	100%	100%	98.9%	–
3 years	98.9%	96.8%	94.4%	–
5 years	94.6%	91.3%	94.4%	–
7 years	Not appeared	86.7%	94.4%	–
Patient +graft survival	83 (87.3%)	76 (80%)	77 (81.1%)
Mean serum creatinine (mg/dL ± SD)
1 year	1.38 ± 0.4	1.48 ± 0.4	1.29 ± 0.34	0.007
3 years	1.35 ± 0.39	1.54 ± 0.47	1.31 ± 0.28	0.001
5 years	1.39 ± 0.35	1.51 ± 0.41	1.42 ± 0.4	0.144
7 years	Not appeared	1.55 ± 0.29	2.06 ± 0.47	0.011
Rejection episodes and time period of  occurrence (years) (range)
Acute rejection score ≤ ag1 at1 av1 ai2	19 (20%)	29 (30.5%)	8 (8.4%)	0.001
PTC score 0	1.03 ± 1.71 (0.01–5.52)	1.21 ± 2 (0.01–6.37)	0.07 ± 0.1 (0.01–0.29)
Acute rejection score > ag1 at1 av1 ai1	0	0	15 (15.8%)	< 0.0001
PTC score > 0			1.65 ± 1.75 (0.01–5.67)
Chronic rejection score ≤ cg1 ct1 cv1  ci1 PTC score 0	3 (3.2%) 4.85 ± 0.7 (4.12–5.52)	11 (11.6%) 5.1 ± 1.25 (3.36–6.77)	1 (1.1%) 5.67	0.003
Chronic rejection score > cg1 ct1 cv1 ci1	0	0	8 (8.4%)	< 0.0001
PTC score > 0			3.15 ± 1.94 (0.96–5.67)
Immunosuppression
Zero	3 (3.6%)	1 (1.3%)	0	0.169
Prednisone (5–10 mg/d)	11 (13.3%)	4 (5.3%)	0	0.001
Two immunosuppressants	43 (51.8%)	43 (56.6%)	0	< 0.0001
3 Immunosuppressants	26 (31.3%)	28 (36.8%)	77 (100%)	< 0.0001
Unremarkable protocol biopsies	8	3	1
Time period (years) (range)	4.41 ± 1.63 (0.52–5.54)	6.03 ± 0.34 (5.69–6.36)	2.66

Figure 2. (a) Kaplan–Meier curve for patient survival of the three groups. (b) Kaplan–Meier curve for death-censored graft survival of the three groups.

Figure 3. Representative protocol biopsy of 59-years-old renal allograft recipient from group-1, who underwent transplantation with his sister’s kidney (HLA match – 1/6) on 31 October 2007. He is on maintenance immunosuppression of prednisone, 5 mg/d since 4 years. Periodic Schiff stain, ×200.