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About the Legorreta Center for Clinical Transplant Tolerance

The Legorreta Center for Clinical Transplant Tolerance at Massachusetts General Hospital is the first center in the world dedicated to establishing clinical transplant tolerance as the standard of care in transplant surgery.

Transplant tolerance is an innovative method that enables the patient’s immune system to maintain the new organ without the need for long-term immunosuppressant medications, allowing for patients to reduce or even discontinue medication while still ensuring the success of the transplant.

Upcoming Event: Mass General Kidney Transplant Symposium

At its upcoming symposium on October 14, 2023, members of the multidisciplinary Mass General kidney transplant team will use didactic presentations, case studies, and open discussions to share the latest advances and approaches in kidney transplantation. Speakers will share innovations in the field—including Tatsuo Kawai, MD, PhD, director of the Legoretta Center for Clinical Transplant Tolerance. Dr. Kawai will present on how to achieve tolerance in kidney transplantation, which combines a bone marrow transplant with a kidney transplant, allowing for patients to come off immunosuppression completely.

The course is available both in person and virtually, and it will offer continuing education credits to participants.

Learn more and register

What Is Organ Rejection?

Following transplant surgery, patients typically require lifelong immunosuppressant medications to stop the immune system from attacking and, ultimately, rejecting the new organ. This rejection process naturally occurs as the immune system's main function is to protect the body from harm by identifying foreign cells and tissues—such as a virus or bacteria. It perceives these foreign “intruders” as a threat and mounts an immune response to attack them. It unfortunately also recognizes transplanted organs as foreign and targets them. Immunosuppressive medications reduce this immune response after transplant surgery to prevent organ rejection.

Frequently Asked Questions

What are the side effects of immunosuppressant medications?

While these medications are globally considered the standard of care for long-term transplant success, they are associated with significant side effects and don’t always prevent a slow form of organ rejection called chronic rejection. The impact of these medications on a patient’s quality of life can be significant and can increase the chance of infections and other complications, like cancer, heart disease, diabetes, and other metabolic diseases.

How is clinical transplant tolerance achieved?

To initiate tolerance after transplant surgery, the Legorreta Center for Clinical Transplant Tolerance at Mass General uses clinically tested treatments that combine donor bone marrow or blood stem cell transplantation with organ transplantation, which allows for the slow reduction of immunosuppressive medications after surgery. This is called simultaneous tolerance.

Our expert team infuses donor bone marrow or blood stem cells into the patient’s body at the same time as they transplant the organ. In the weeks following surgery, the cells expand and train the immune system to recognize the new organ and accept it as its own rather than attack it.

While immunosuppressive medications are still required immediately following surgery, they will be carefully and intentionally reduced over 9-18 months—sometimes, until no medication is needed at all.

Am I eligible if I received kidney transplant in the past?

We also aim to eliminate the need for lifelong immunosuppression in patients who underwent kidney transplant surgery in the past. Our preclinical studies have proven that this is possible, and we are currently enrolling patients into an FDA-approved clinical trial for “Delayed Tolerance.”

This approach is possible as long as the bone marrow or blood stem cells from the original kidney donor are available. For those who received their new organ through the deceased donor waitlist, we can use the donor’s bone marrow cells if they were stored at the time of the original transplant surgery. For recipients who received their new organ through living donation, the delayed tolerance treatment is available anytime as long as their original living donor is willing and medically cleared to provide bone marrow or blood stem cells.

While delayed tolerance treatment at Mass General is currently only available for kidney transplant patients, our team is working to expand this option to include other organ recipients in the future.

How do I schedule an appointment?

You will need to be a kidney transplant candidate to qualify for the transplant tolerance protocol. If you are a kidney transplant patient, request an appointment using our secure online form.


What to Expect: New Transplant Patients

Transplant tolerance care typically begins once the living donor is identified and ready to donate their kidney. Prepare for the transplant tolerance journey by clicking the arrow buttons below to see each step in the process.

What to Expect: Former Transplant Patients

Patients who received their donor organ in the past can still receive transplant tolerance care as long as the bone marrow or blood stem cells from the original kidney donor are available. Prepare for the transplant tolerance journey by clicking the arrow buttons below to see each step in the process.