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Transplantation Tolerance through Hematopoietic Chimerism

List of authors.
  • Thomas R. Spitzer, M.D.,
  • and David H. Sachs, M.D.

Stunning advances in human transplantation have been tempered by the immunologic consequences of histoincompatibility between donor and recipient — namely, allograft rejection after solid-organ transplantation and graft-versus-host disease (GVHD) after hematopoietic stem-cell (bone marrow) transplantation (HSCT). The separation of GVHD from the graft-versus-tumor effect and the induction of functional immune tolerance, defined by the absence of a destructive immune response in the absence of systemic immunosuppression, have been considered the “Holy Grail” of HSCT and solid-organ transplantation, respectively. Freedom from immunosuppression after organ transplantation has a tremendous potential upside, since lifelong immunosuppressive therapy is sometimes complicated by debilitating or life-threatening . . .

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Funding and Disclosures

Disclosure forms provided by the authors are available with the full text of this editorial at NEJM.org.

Author Affiliations

From the Departments of Medicine (T.R.S.) and Surgery (D.H.S.), Massachusetts General Hospital, Boston; and the Departments of Medicine and Surgery, Columbia University, New York (D.H.S.).