case study of tolerance and chimerism after renal and hematopoietic cell transplantation

1. CASE STUDY: TOLERANCE AND CHIMERISM
AFTER RENAL AND HEMATOPOIETIC-CELL
PRESENTATION BY:
SHAHZENAN AL-AZZAWI
VESILENUR ÇELIK

2. TEXT
RESOURCES
▸ Main resource: Tolerance and Chimerism after Renal and
Hematopoietic-Cell Transplantation by John D. Scandling
▸ Secondary resources:
▸ Induction of Tolerance through Mixed Chimerism by
David H. Sachs1, Tatsuo Kawai2, and Megan Sykes.
▸ Blood Group Chimerism in Human Multiple Births Is Not
Rare by Bob A. van Dijk, Dorret I. Boomsma, and Achile
J.M. de Man

3. TOLERANCE AND CHIMERISM AFTER RENAL AND HEMATOPOIETIC-CELL
JOURNAL INFORMATION
▸ Journal: the new England journal of medicine
▸ impact factor: 72.406
▸ Publisher: Massachusetts Medical Society
▸ Publication history: 1812–present
▸ Frequency: weekly

4. TOLERANCE AND CHIMERISM AFTER RENAL AND HEMATOPOIETIC-CELL
RESEARCH INFORMATION
‣ Qualitative research method: case study
‣ Publication date: January 24, 2008
‣ Digital object identifier: 10.1056/NEJMoa074191
‣ Title: Tolerance and Chimerism after Renal and Hematopoietic-Cell
Transplantation
‣ authors: John D. Scandling, M.D., Stephan Busque, M.D., Sussan Dejbakhsh-
Jones, M.S., Claudia Benike, B.S., Maria T. Millan, M.D., Judith A. Shizuru,
M.D., Ph.D., Richard T. Hoppe, M.D., Robert Lowsky, M.D., Edgar G.
Engleman, M.D., and Samuel Strober, M.D.
‣ Publishing institute: Stanford University School of Medicine, Stanford, CA.

5. INDUCTION OF TOLERANCE THROUGH MIXED CHIMERISM
BACKGROUND
‣ Organ Transplant complication covered: graft-verses-
host diseases (GVHD) and infection.
‣ Immune tolerance: is a state of unresponsiveness of the
immune system to substances or tissue that have the
capacity to elicit an immune response in given organism.

6. TEXT
BACKGROUND
‣ Chimerae: a state where an organism has cells from two or more
zygotes.
‣ Mixed chimerism: refers to a state in which the lymphohematopoietic
system of the recipient of allogeneic (genetically different)
hematopoietic stem cells comprises a mixture of host and donor cells.
‣ lymphohematopoietic system: responsible for producing (-poietic)
lymphocytes (lympho-) and blood cells (hemato-).
‣ the hematopoietic chimerism that occurs after bone marrow
transplantation carries with it transplantation tolerance for any other
tissue or organ from the same donor.

7. TOLERANCE AND CHIMERISM AFTER RENAL AND HEMATOPOIETIC-CELL
CASE
▸ The patient is a 47-year-old white man with end-stage renal
disease of unknown origin at the time of preemptive kidney
transplantation. (to avoid complications)
▸ The kidney donor was his 49-year-old brother.

8. TOLERANCE AND CHIMERISM AFTER RENAL AND HEMATOPOIETIC-CELL
CASE:
▸ aim: inducing immunetolerance of organ transplant
▸ Method used: inducing persistent mixed blood and
immune-cell chimerism by infusing hematopoietic cells
from the organ donor before or after transplantation of
organ
▸ Mechanism of action: the continued presence of organ
donor’s immune cells in the recipient’s thymus and
peripheral lymphoid tissue promotes and maintains
immune tolerance.

9. THANK YOU FOR
YOUR ATTENTION