'Kidney Transplant Performed First'... Simultaneous Improvement in Aplastic Anemia and Renal Failure

Seoul St. Mary's Hospital Organ Transplant Center Publishes Treatment Strategy in the American Journal of Transplantation

All Four Patients with Both Aplastic Anemia and End-Stage Renal Failure Show Improvement

Hematologic Recovery Observed in Some Patients Without Hematopoietic Stem Cell Transplantation

The Organ Transplant Center at Seoul St. Mary's Hospital announced on March 30 that they observed clinical improvement by adopting a treatment strategy of performing kidney transplantation first in patients suffering from both severe aplastic anemia and end-stage renal failure. The related research was recently published in the international journal 'American Journal of Transplantation'.

From left: Jeong Byungha, Professor of Nephrology, Seoul St. Mary's Hospital; Silvia Park, Professor of Hematology, Seoul St. Mary's Hospital. Seoul St. Mary's Hospital

The research team analyzed the treatment outcomes of four patients diagnosed with both conditions and explained that all patients showed stable recovery of kidney function along with significant hematologic improvement.

Severe aplastic anemia is a disease characterized by a general decrease in blood cells due to impaired bone marrow function, and hematopoietic stem cell transplantation is known as a curative treatment. For end-stage renal failure, kidney transplantation is the most effective therapy. The challenge arises when both conditions coexist, as there are no clear guidelines on the order of treatments, making clinical decision-making difficult.

Considering these limitations, the researchers chose a strategy of performing kidney transplantation first, followed by hematopoietic stem cell transplantation if necessary. All patients were transfusion-dependent, but after kidney transplantation, they experienced immediate recovery of graft kidney function and maintained stable outcomes for one year without acute rejection or major complications.

Among them, two patients received additional hematopoietic stem cell transplantation from the same donor about three months after kidney transplantation. These two patients maintained stable outcomes even after discontinuing immunosuppressive drugs. The medical team interpreted this as the possibility of immunologic remission due to the formation of donor chimerism.

The remaining two patients, even without receiving hematopoietic stem cell transplantation, gradually improved in anemia and thrombocytopenia and were able to overcome their transfusion-dependent state. Their bone marrow function also showed signs of recovery. The research team suggested that the combined effects of reduced uremic toxins after kidney transplantation, alleviation of inflammation, and the impact of immunosuppressants may have contributed to these results.

Jeong Byeongha, Professor of Nephrology at Seoul St. Mary's Hospital, who participated in the study, said, "The finding that hematologic recovery can be achieved with kidney transplantation alone in some patients is a clinically significant result." He added, "It is necessary to establish criteria for selecting suitable patient groups through systematic prospective studies in the future."

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