Induction of donor-specific immunological tolerance in order to eliminate the lifelong systemic
immunosuppressive therapy and their deleterious side effects as well as to prevent graft loss due
to acute or chronic rejection or drug toxicity has been considered the "Holy Grail" of transplantation.
The only effective approach of inducing tolerance is combined organ (e.g. kidney) and donor bone marrow
transplantation. The hallmark of this protocol is establishment of chimerism and preferentially
mixed chimerism using non-meyloablative condition which reduces the risk of GVHD, as well as its
feasibility and safety for tolerance induction even in HLA-mismatched kidney graft recipients. The focus
of this review is to discuss the last findings of clinical trials mainly from three medical centers as
pioneers for designing and implementing tolerance protocols using chimerism-based approaches. Finally,
the merits and drawbacks of these protocols are discussed with regard to the feasibility of such
protocols for deceased donor grafts and more widespread application in clinical transplantation.
Keywords: Allograft, chimerism, kidney, stem cells, tolerance, transplantation.
Rights & PermissionsPrintExport