The Differential Effects of 3 Different Immunosuppressive

Life-long immunosuppressive (IS) therapy is typically required in the great majority of
organ transplants. Immunobiologically correct IS dosing, tapering to low levels and/or
monotherapy could lower the incidence of complications related to IS and improve long term
graft and patient survival. The current standard of IS care for liver transplant recipients
are the calcineurin-inhibitors (CNIs) tacrolimus (TAC) and cyclosporine (CSA), although
alternative IS drugs such as mycophenolate mofetil (MMF) and sirolimus (SRL) are available
for use in select patients. This is also true for kidney, pancreas and heart transplant
recipients, with TAC being favored in each case. The ideal IS agent is one that can be given
at low levels such that both rejection and long term toxicity are minimized. Directly
related to IS minimization might be the development of a regulatory, "tolerance profile", as
assessed by ex vivo immunophenotyping and functional assays that might test these specific
IS agents singly, in combination or even in sequence.

Human Tregs and DCregs can be more predominantly generated in the presence of one of three
IS agents with different modes of action, i.e., TAC, MMF or SRL, and in different conditions
of antigen presentation and alloimmune incompatibility.

This is a bench protocol studying the effects of TAC, MMF and SRL on pre operative living
renal recipient donor pair.

Inclusion Criteria:

- Adults 18 years of Age or Older

- Undergoing living donor renal transplant

Exclusion Criteria:

- No active infection or history of malignancy

- No HIV infection

- No Hepatitis C (HCV) infection

- No prior transplant (kidney or other organ)

- No chromic use of immunosuppressive therapy or history of autoimmune disease