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*
Division of Pediatric Oncology, Dana-Farber Cancer Institute, and Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115;
Department of Surgery, Univeristy of Pittsburgh Health System, Pittsburgh, PA 15261; and
Institute for Cellular Therapeutics, University of Louisville, Louisville, KY 40202
The association of preformed anti-donor Abs with the hyperacute
rejection of bone marrow and solid organ allografts and the persistence
of the anti-donor immune response secondary to immunologic memory
make allosensitization an absolute contraindication to transplantation.
Mixed allogeneic (A + B
A) bone marrow chimerism has been
demonstrated to confer donor-specific tolerance in nonsensitized
recipients, but has not been evaluated in the setting of
allosensitization. The current study documents that despite significant
anti-donor sensitization, mixed allogeneic engraftment is possible
and provides a marked advantage over fully allogeneic (BA) models.
Moreover, the acceptance of donor skin grafts and loss of circulating
anti-donor Abs suggest that allosensitization can be abrogated with
the induction of stable mixed allogeneic
chimerism.
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