Updates in tolerance: future directions to improve kidney allograft survival
1
Issued Date
2026-03-01
Resource Type
eISSN
14736543
Scopus ID
2-s2.0-105028971677
Pubmed ID
41527400
Journal Title
Current Opinion in Nephrology and Hypertension
Volume
35
Issue
2
Start Page
262
End Page
269
Rights Holder(s)
SCOPUS
Bibliographic Citation
Current Opinion in Nephrology and Hypertension Vol.35 No.2 (2026) , 262-269
Suggested Citation
Traitanon O., Tantisattamo E., Anumas S., Krisanapan P., Eiamsitrakoon T., Tasanarong A., Chancharoenthana W. Updates in tolerance: future directions to improve kidney allograft survival. Current Opinion in Nephrology and Hypertension Vol.35 No.2 (2026) , 262-269. 269. doi:10.1097/MNH.0000000000001142 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114821
Title
Updates in tolerance: future directions to improve kidney allograft survival
Author's Affiliation
Thammasat University
Faculty of Tropical Medicine, Mahidol University
UCI Medical Center
Faculty of Medicine Ramathibodi Hospital, Mahidol University
VA Long Beach Healthcare System
Oakland University William Beaumont School of Medicine
Faculty of Medicine, Thammasat University
Thammasat University Hospital
Pacific Northwest University of Health Sciences
Faculty of Tropical Medicine
Faculty of Tropical Medicine, Mahidol University
UCI Medical Center
Faculty of Medicine Ramathibodi Hospital, Mahidol University
VA Long Beach Healthcare System
Oakland University William Beaumont School of Medicine
Faculty of Medicine, Thammasat University
Thammasat University Hospital
Pacific Northwest University of Health Sciences
Faculty of Tropical Medicine
Corresponding Author(s)
Other Contributor(s)
Abstract
PURPOSE OF REVIEW: Long-term kidney allograft survival remains limited by chronic rejection and the toxicities of lifelong immunosuppression. Donor-specific tolerance, the acceptance of the graft without continuous pharmacological therapy, has long been considered the ultimate goal of transplantation. This review summarizes recent clinical advances in tolerance-inducing strategies and outlines future directions for clinical translation. RECENT FINDINGS: Clinical progress has accelerated in the past decade. Mixed hematopoietic chimerism protocols have matured from single-center feasibility studies to a recent phase 3 randomized trial in human leukocyte antigen (HLA)-identical recipients, achieving sustained immunosuppression-free survival with improved safety outcomes regulatory T cell therapies, tested across multiple early-phase trials, have consistently demonstrated safety, biological activity, and scalability in multicenter settings, with new approaches entering clinical development. SUMMARY: Tolerance in kidney transplantation is transitioning from conceptual aspiration to clinical feasibility. Landmark chimerism trials confirm that operational tolerance is possible in selected populations. Future priorities include refining conditioning regimens to reduce toxicity and extending eligibility to higher-risk recipients. Together, these developments suggest that tolerance-based strategies may ultimately transform kidney transplantation from chronic immunosuppression to durable immune re-education.