Immunosuppressive-Free Renal Allograft Function After Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report.

Objective: We describe a rare case of satisfactory renal allograft function without immunosuppressive therapy following allogeneic hematopoietic stem cell transplantation (alloHSCT).

Case report: The patient was a 64-year-old male who had undergone a kidney transplant from a sibling donor in 2007. After 16 years, he required alloHSCT for acute myeloid leukemia (AML), with the same sibling serving as the donor for both transplants. HLA was a 50% match. Post-alloHSCT, immunosuppressive therapy was discontinued, and the renal allograft function remained stable. The patient later developed severe complications and succumbed to infection. Insights into the precise tolerance mechanisms were limited because laboratory evaluation for chimerism was not performed.

Conclusion: There is potential for immunosuppressive-free renal allograft function after alloHSCT. This case underscores the significant risk of infection-related mortality. To achieve the best outcome, rigorous patient selection, tailored conditioning regimens, robust infection prevention strategies, and the possibility of combined transplantation for carefully selected patients are needed.