Yakubu Idris, Haririan Abdolreza, Bartlett Stephen, Sparkes Tracy
Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
Case Rep Transplant. 2018 Jun 27;2018:9842893. doi: 10.1155/2018/9842893. eCollection 2018.
Renal transplantation between monozygous identical twins provides an opportunity to utilize minimal immunosuppression to maintain stable allograft function, thereby alleviating the toxicities of immunosuppressive therapy. Despite monozygosity, there is a possibility of discordant protein presentation in identical twins that could trigger alloimmune response and lead to graft injury. Therefore, the optimal immunosuppression regimen in this patient population is unknown, and the safety of immunosuppression withdrawal remains controversial. Herein, we describe two patients who underwent successful renal transplantation from monozygotic identical twin donors. Monozygosity was determined using short tandem repeat (STR) analysis. All immunosuppression was successfully discontinued at 2 days and 3 weeks, respectively, after transplantation. Both patients are alive with functioning renal grafts at 1 year and 5 years after transplant, respectively. These two cases suggest that immunosuppression can be withdrawn safely and rapidly in select monozygous identical twin renal transplant recipients.
同卵双胞胎之间的肾移植提供了一个机会，即利用最小程度的免疫抑制来维持稳定的同种异体移植肾功能，从而减轻免疫抑制治疗的毒性。尽管是同卵双胞胎，但同卵双胞胎中仍有可能出现不一致的蛋白质呈递，这可能触发同种免疫反应并导致移植物损伤。因此，该患者群体的最佳免疫抑制方案尚不清楚，停用免疫抑制的安全性仍存在争议。在此，我们描述了两名接受同卵双胞胎供体成功肾移植的患者。使用短串联重复序列（STR）分析确定同卵性。移植后分别在2天和3周成功停用了所有免疫抑制。两名患者在移植后1年和5年时均存活，肾移植功能良好。这两个病例表明，在选定的同卵双胞胎肾移植受者中，可以安全、迅速地停用免疫抑制。
