Tolérance dans la transplantation rénale allogénique de donneur vivant apparenté
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La tol�rance � la transplantation peut �tre d�finie comme la survie normale du greffon sans immunosuppression, tout en pr�servant une immunit� intacte. Les strat�gies d'induction de la tol�rance (TI) comprennent l'induction du chim�risme et/ou la suppression clonale. La transfusion sp�cifique au donneur (DST) et les cellules souches (CS) sont apparues comme des strat�gies de TI. Dans cette �tude ouverte en deux bras parall�les, r�alis�e sous conditionnement non my�loablatif avec la DST comme premier bras et les CS comme second bras, sans utilisation d'immunosuppression conventionnelle. La surveillance comprenait la CrS (mg/dL), le DSA et le MLR. Des biopsies protocolaires �taient pr�vues apr�s 100 jours, puis annuellement chez les patients consentants. En cas de rejet, de DSA ou de MLR, une immunosuppression de secours �tait pr�vue. La survie des patients au cours des deux premi�res ann�es �tait de 100 % dans les deux groupes; � 5 ans apr�s la greffe, elle �tait de 80 % avec les CS et de 90 % avec la TSD. La survie du greffon, censur�e sur la base des d�c�s, �tait de 100 % au cours de la premi�re ann�e dans les deux groupes, et � 5 ans, de 80 % avec la greffe autologue et de 70 % avec la greffe allog�nique. La SCr moyenne �tait de 1,52 avec la greffe autologue et de 1,97 avec la greffe allog�nique. Cinq patients du groupe greffe autologue et 3 du groupe greffe allog�nique ont b�n�fici� d'une TI r�ussie.
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