Kidney transplantation for treatment of end-stage kidney disease after haematopoietic stem cell transplantation: case series and literature review

  • Akihiro Tsuchimoto
  • Kosuke Masutani
  • Kazuya Omoto
  • Masayoshi Okumi
  • Yasuhiro Okabe
  • Takehiro Nishiki
  • Morihito Ota
  • Toshiaki Nakano
  • Kazuhiko Tsuruya
  • Takanari Kitazono
  • Masafumi Nakamura
  • Hideki Ishida
  • Kazunari Tanabe
  • the Japan Academic Consortium of Kidney Transplantation (JACK) Investigators
Original article



The safety of kidney transplantation (KT) for end-stage kidney disease (ESKD) after haematopoietic stem cell transplantation (HSCT) for haematological disease has not been investigated thoroughly.


In this retrospective multicentre study, we investigated the clinical courses of six ESKD patients that received KT after HSCT for various haematological diseases. Data for six such patients were obtained from three institutions in our consortium.


Two patients with chronic myeloid leukaemia, one with refractory aplastic anaemia and another one with acute lymphocytic leukaemia received bone marrow transplantation. One patients with acute lymphocytic leukaemia received umbilical cord blood transplantation, and one with mantle cell lymphoma received peripheral blood stem cell transplantation. The patients developed ESKD at a median of 133 months after HSCT. Two patients who received KT and HSCT from the same donor were temporarily treated with immunosuppressive drugs. The other patients received KT and HSCT from different donors and were treated with antibody induction using our standard regimens. For one patient with ABO-incompatible transplantation, we added rituximab, splenectomy, and plasmapheresis. In the observational period at a median of 51 months after KT, only one patient experienced acute T-cell-mediated rejection. Four patients underwent hospitalization because of infection and fully recovered. No patient experienced recurrence of their original haematological disease. All patients survived throughout the observational periods, and graft functions were preserved.


Despite the high infection frequency, survival rates and graft functions were extremely good in patients compared with previous studies. Therefore, current management contributed to favourable outcomes of these patients.


Bone marrow transplantation GVHD Infection Rejection Malignancy Leukemia 



End-stage kidney disease


Graft-versus-host disease


Haematopoietic stem cell transplantation


Kidney transplantation



We thank Dr Nicholas Rufaut, PhD, and Mitchell Arico from Edanz Group ( for editing a draft of this manuscript. We appreciate the support from Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan), who provided expert assistance with data management.

JACK Participating Centres: Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan; Investigators, Kazunari Tanabe, Hideki Ishida, Masashi Inui, Kazuya Omoto, Tomokazu Shimizu, Masayoshi Okumi, Toshihito Hirai, and Daisuke Toki; Department of Medicine, Kidney Centre, Tokyo Women’s Medical University, Tokyo, Japan; Investigator, Kohei Unagami; Department of Transplant Surgery, Kidney Centre, Toda Chuo General Hospital; Investigator, Hiroshi Toma; Department of Urology, Ohkubo Hospital; Investigator, Hiroki Shirakawa; Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan; Investigators, Yasuhiro Okabe, Atsuchi Doi, Keizo Kaku, and Kei Kurihara; Department of Surgery, Tomishiro Central Hospital, Okinawa; Investigator, Ota Morihito. JACK Data Centre: Katsunori Shimada, Department of Biostatistics, STATZ Institute, Inc., Tokyo, Japan. JACK General Management Office: Masayoshi Okumi, Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan.

Author contributions

AT and KM participated in planning the research and data collection and analysis. YO, TN and MO participated in data collection. MO significantly contributed to the establishment of the consortium supporting this study. TN, KT, MN, HI and KT participated in the management of the research. All authors contributed to writing the manuscript.

Compliance with ethical standards

Conflict of interest

Potential financial conflicts of interest: Astellas Pharma Inc. (Tokyo, Japan) supported this study and Kazunari Tanabe with a grant. The sponsor was not involved in the study design, patient enrolment, data collection, analysis, interpretation, or preparation of the manuscript.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number UMIN000018327) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.


  1. 1.
    Imai H, Oyama Y, Miura AB, Endoh M. Sakai H. Hematopoietic cell transplantation-related nephropathy in Japan. Am J Kidney Dis. 2000;36:474–80.CrossRefGoogle Scholar
  2. 2.
    Choi M, Sun CL, Kurian S, et al. Incidence and predictors of delayed chronic kidney disease in long-term survivors of hematopoietic cell transplantation. Cancer. 2008;113:1580–7.CrossRefGoogle Scholar
  3. 3.
    Ando M, Ohashi K, Akiyama H, et al. Chronic kidney disease in long-term survivors of myeloablative allogeneic haematopoietic cell transplantation: prevalence and risk factors. Nephrol Dial Transpl. 2010;25:278–82.CrossRefGoogle Scholar
  4. 4.
    Miralbell R, Bieri S, Mermillod B, et al. Renal toxicity after allogeneic bone marrow transplantation: the combined effects of total-body irradiation and graft-versus-host disease. J Clin Oncol. 1996;14:579–85.CrossRefGoogle Scholar
  5. 5.
    Chappell ME, Keeling DM, Prentice HG. Sweny P. Haemolytic uraemic syndrome after bone marrow transplantation: an adverse effect of total body irradiation? Bone Marrow Transpl. 1988;3:339–47.Google Scholar
  6. 6.
    Lawton CA, Cohen EP, Barber-Derus SW, et al. Late renal dysfunction in adult survivors of bone marrow transplantation. Cancer. 1991;67:2795–800.CrossRefGoogle Scholar
  7. 7.
    Kist-van Holthe JE, Goedvolk CA, Brand R, et al. Prospective study of renal insufficiency after bone marrow transplantation. Pediatr Nephrol. 2002;17:1032–7.CrossRefGoogle Scholar
  8. 8.
    Hamawi K, De Magalhaes-Silverman M. Bertolatus JA. Outcomes of renal transplantation following bone marrow transplantation. Am J Transpl. 2003;3:301–5.CrossRefGoogle Scholar
  9. 9.
    Sayegh MH, Fine NA, Smith JL, Rennke HG, Milford EL. Tilney NL. Immunologic tolerance to renal allografts after bone marrow transplants from the same donors. Ann Intern Med. 1991;114:954–5.CrossRefGoogle Scholar
  10. 10.
    Jacobsen N, Taaning E, Ladefoged J, Kristensen JK. Pedersen FK. Tolerance to an HLA-B,DR disparate kidney allograft after bone-marrow transplantation from same donor. Lancet. 1994;343:800.CrossRefGoogle Scholar
  11. 11.
    Helg C, Chapuis B, Bolle JF, et al. Renal transplantation without immunosuppression in a host with tolerance induced by allogeneic bone marrow transplantation. Transplantation. 1994;58:1420–2.PubMedGoogle Scholar
  12. 12.
    Sorof JM, Koerper MA, Portale AA, Potter D, DeSantes K. Cowan M. Renal transplantation without chronic immunosuppression after T cell-depleted, HLA-mismatched bone marrow transplantation. Transplantation. 1995;59:1633–5.PubMedGoogle Scholar
  13. 13.
    Fangmann J, Kathrin Al-Ali H, Sack U, et al. Kidney transplant from the same donor without maintenance immunosuppression after previous hematopoietic stem cell transplant. Am J Transpl. 2011;11:156–62.CrossRefGoogle Scholar
  14. 14.
    Garrouste C, Socie G. Heng AE. Kidney transplantation after previous hematopoietic stem cell transplant: need of immunosuppressive treatment? Transpl Int. 2014;27:e92–3.CrossRefGoogle Scholar
  15. 15.
    Butcher JA, Hariharan S, Adams MB, Johnson CP, Roza AM. Cohen EP. Renal transplantation for end-stage renal disease following bone marrow transplantation: a report of six cases, with and without immunosuppression. Clin Transpl. 1999;13:330–5.CrossRefGoogle Scholar
  16. 16.
    Younge J, Duffner UA, Bunchman T. Abdel-Mageed A. Ten year follow-up for a patient postmatched unrelated donor bone marrow transplant followed by same donor kidney transplant: normal renal function without immunosuppression. Transplantation 2015;99:e162.CrossRefGoogle Scholar
  17. 17.
    Tanaka T, Ishida H, Shirakawa H, Amano H, Nishida H. Tanabe K. Renal transplantation after myeloablative and non-myeloablative hematopoietic cell transplantation from the same donor. Int J Urol. 2007;14:1044–5.CrossRefGoogle Scholar
  18. 18.
    Haas M, Sis B, Racusen LC, et al. Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant. 2014;14:272–83.CrossRefGoogle Scholar
  19. 19.
    Port FK, Wolfe RA, Mauger EA, Berling DP. Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA. 1993;270:1339–43.CrossRefGoogle Scholar
  20. 20.
    Ojo AO, Port FK, Wolfe RA, Mauger EA, Williams L. Berling DP. Comparative mortality risks of chronic dialysis and cadaveric transplantation in black end-stage renal disease patients. Am J Kidney Dis. 1994;24:59–64.CrossRefGoogle Scholar
  21. 21.
    Schnuelle P, Lorenz D, Trede M. Van Der Woude FJ. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol. 1998;9:2135–41.PubMedGoogle Scholar
  22. 22.
    Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725–30.CrossRefGoogle Scholar
  23. 23.
    Goto N, Okada M, Yamamoto T, et al. Association of dialysis duration with outcomes after transplantation in a Japanese cohort. Clin J Am Soc Nephrol. 2016;11:497–504.CrossRefGoogle Scholar
  24. 24.
    Rubin RH. Infectious disease complications of renal transplantation. Kidney Int. 1993;44:221–36.CrossRefGoogle Scholar
  25. 25.
    Meier-Kriesche HU, Arndorfer JA. Kaplan B. Association of antibody induction with short- and long-term cause-specific mortality in renal transplant recipients. J Am Soc Nephrol. 2002;13:769–72.PubMedGoogle Scholar
  26. 26.
    Masutani K, Tsuchimoto A, Kurihara K, et al. Histological analysis in ABO-compatible and ABO-incompatible kidney transplantation by performance of 3- and 12-month protocol biopsies. Transplantation 2017;101:1416–1422.CrossRefGoogle Scholar
  27. 27.
    Chandrasekharan D, Issa F. Wood KJ. Achieving operational tolerance in transplantation: how can lessons from the clinic inform research directions? Transpl Int. 2013;26:576–89.CrossRefGoogle Scholar
  28. 28.
    Kawai T, Cosimi AB, Spitzer TR, et al. HLA-mismatched renal transplantation without maintenance immunosuppression. N Engl J Med. 2008;358:353–61.CrossRefGoogle Scholar
  29. 29.
    Scandling JD, Busque S, Dejbakhsh-Jones S, et al. Tolerance and chimerism after renal and hematopoietic-cell transplantation. N Engl J Med. 2008;358:362–8.CrossRefGoogle Scholar
  30. 30.
    Vanikar AV, Goplani KR, Feroz A, et al. Operational tolerance in living-related renal transplantation: a single-center experience. Transpl Proc. 2011;43:1551–8.CrossRefGoogle Scholar
  31. 31.
    Curtis RE, Rowlings PA, Deeg HJ, et al. Solid cancers after bone marrow transplantation. N Engl J Med. 1997;336:897–904.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Akihiro Tsuchimoto
    • 1
  • Kosuke Masutani
    • 2
  • Kazuya Omoto
    • 3
  • Masayoshi Okumi
    • 3
  • Yasuhiro Okabe
    • 4
  • Takehiro Nishiki
    • 5
  • Morihito Ota
    • 6
  • Toshiaki Nakano
    • 1
  • Kazuhiko Tsuruya
    • 1
  • Takanari Kitazono
    • 1
  • Masafumi Nakamura
    • 4
  • Hideki Ishida
    • 3
  • Kazunari Tanabe
    • 3
  • the Japan Academic Consortium of Kidney Transplantation (JACK) Investigators
  1. 1.Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of MedicineFukuoka UniversityFukuokaJapan
  3. 3.Department of UrologyTokyo Women’s Medical UniversityTokyoJapan
  4. 4.Department of Surgery and Oncology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  5. 5.Department of SurgeryFukuoka Red Cross HospitalFukuokaJapan
  6. 6.Department of SurgeryTomishiro Central HospitalOkinawaJapan

Personalised recommendations