Krishnan N, Buchanan P M, Dzebisashvili N, Xiao H, Schnitzler M A, Brennan D C
University of Massachusetts, Worcester, MA, USA.
Am J Transplant. 2008 Nov;8(11):2343-51. doi: 10.1111/j.1600-6143.2008.02378.x. Epub 2008 Sep 19.
We describe the case of a 24-year-old female with end-stage renal disease from focal segmental glomerulosclerosis (FSGS) diagnosed at age 16, who underwent monozygotic triplet transplantation at age 21 from her sister. Monozygosity was established by buccal smear DNA PCR amplification using short tandem repeat (1) profiling for 16 genetic alleles. All immunosuppression was discontinued by 1 month posttransplant. To evaluate the use of immunosuppression in HLA identical monozygotic transplantation, we interrogated the OPTN (Organ Procurement Transplant Network) database for all transplants conducted from 1987 to 2006. We identified 194 probable identical twin transplantations based on age, gender, race, ethnic category, blood type and HLA match. We evaluated the use of various immunosuppressive agents at discharge, 6 months and 1, 2 and 3 years after transplantation. Seventy-one percent of these patients at discharge and 34% at the end of 1 year were on immunosuppression. At discharge 61% received steroids and 30% received calcineurin inhibitors and 66% of these remained on calcineurin inhibitors at 1 year. Renal function was superior among those not maintained on immunosuppression. Thus, monozygotic transplantation confers an immunologic advantage that allows immunosuppression elimination despite a risk of recurrent glomerular disease such as FSGS with appropriate evaluation and management.
我们描述了一名24岁女性的病例，她在16岁时被诊断为局灶节段性肾小球硬化（FSGS）导致的终末期肾病，21岁时接受了来自其姐姐的同卵三胞胎移植。通过使用短串联重复序列（1）对16个基因等位基因进行分析的口腔涂片DNA PCR扩增确定了同卵性。移植后1个月停用所有免疫抑制药物。为了评估在HLA相同的同卵移植中免疫抑制的使用情况，我们查询了器官获取与移植网络（OPTN）数据库中1987年至2006年进行的所有移植。我们根据年龄、性别、种族、族裔类别、血型和HLA匹配确定了194例可能的同卵双胞胎移植。我们评估了出院时、移植后6个月以及1年、2年和3年使用各种免疫抑制药物的情况。这些患者中71%在出院时以及1年末34%正在接受免疫抑制治疗。出院时61%接受了类固醇治疗，30%接受了钙调神经磷酸酶抑制剂治疗，其中66%在1年时仍在使用钙调神经磷酸酶抑制剂。未接受免疫抑制治疗的患者肾功能更好。因此，同卵移植具有免疫优势，尽管存在复发性肾小球疾病（如FSGS）的风险，但通过适当的评估和管理，仍可停用免疫抑制治疗。
