Study of Combined Kidney and Blood Stem Cell Transplant From a Brother or Sister Donor

Eligibility Criteria

• 1. Males and females ages 18 years and older receiving living donor kidney transplant from an HLA-identical sibling at UCLA Medical Center.
• 2. Agrees to participate in the study and is able to give informed consent.
• 3. Resides or is willing to stay within 3 hours distance from UCLA Medical Center by ground transportation for the first three to six months of the trial at the physician's discretion.
• 4. Meets institutional criteria for kidney and HSPC transplant.
• 5. No known contraindication to administration of rATG or radiation.
• 6. If patient is a female of reproductive potential (i.e., no documented absence of ovaries or uterus, history of tubal ligation, or post-menopausal status) patient must be confirmed not pregnant by a serum or urine pregnancy test) and must agree to practice a reliable form of contraception including hormonal treatments, barrier methods or intrauterine device for at least 12 months post-transplant. Karnofsky Performance Score ≥ 70.
• 7. Adequate cardiac function defined as left ventricular ejection fraction (LVEF) ≥ 40% by MUGA (Multi Gated Acquisition) scan or echocardiogram.
• 8. Adequate pulmonary function defined as FVC and DLCO of greater than or equal to 50% of predicted.
• 9. Adequate liver function defined as total bilirubin ≤ 1.5 times the upper limit of normal and AST/ALT ≤ 2.0 times the upper limit of normal.
• 10. Adequate social support based on evaluation by the UCLA renal transplant team licensed clinical social worker.
• 1. Donor is identical twin.
• 2. ABO incompatibility with donor.
• 3. Previous solid organ transplant
• 4. Multi-organ transplantation
• 5. Previous treatment with rATG or a known allergy to rabbit proteins
• 6. History of active malignancy within the past 5 years with the exception of non-melanomatous skin cancer.
• 7. Pregnant (confirmed by urine or serum pregnancy test) or lactating.
• 8. Leukopenia (with a white blood cell count \< 3,000/ µL) or thrombocytopenia (with a platelet count \< 100,000/ µL).
• 9. Active bacterial, fungal, mycobacterial or viral infection (including active hepatitis B and/or C).
• 10. Positive HLA DSA
• 11. Seropositivity for HIV 1, HIV 2, HTLVI, HTLV II
• 12. Active West Nile Virus infection
• 13. Renal disease with high risk of recurrence (i.e., focal segmental glomerulosclerosis).
• 14. Advanced hepatic fibrosis or cirrhosis secondary to hepatitis B and/or C diagnosis.
• 15. Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia; active extra-renal autoimmune disease requiring immunosuppression.
• 16. Active extra-renal autoimmune disease requiring immunosuppression.
• 17. Neuropsychiatric illness that precludes the ability to give informed consent and/or places the patient as high risk for non-compliance with the safety monitoring requirements of the study.
• 18. May not have received other immunosuppressive medications, including but not limited to alemtuzumab, belatacept, sirlolimus, everolimus, azathioprine, basiliximab, and eculizumab within six months of the study treatment. Use of corticosteroids prescribed for a time-limited indication (\</= 4 weeks) and stopped at least 4 weeks before the kidney transplant is acceptable.
• 19. May not have received immunotherapy drugs such as immune checkpoint inhibitors (e.g. pembrolizumab, nivolumab, and ipilimumab), tumor necrosis factor inhibitors, rituximab, and interleukin-2 within six months of the study treatment.
• 20. Current or active abuse of alcohol and/or drugs within last 6 months.
• 21. BMI 40 or greater.