Wu Guosheng, Zhao Qingchuan, Wang Mian, Wei Jiangpeng, Sun Hao, Zheng Jianyong, Fan Daiming
Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
Transplant Direct. 2018 Jul 16;4(8):e374. doi: 10.1097/TXD.0000000000000807. eCollection 2018 Aug.
The availability of an identical twin donor that allows avoidance of complications related to graft rejection and immunosuppression represents an ideal treatment option for irreversible intestinal failure.
We described a 45-year-old woman who lost most of her small bowel due to acute superior mesenteric thrombosis received a living-related small bowel transplant from her identical-twin sister. Monozygosity was established by buccal smear DNA amplification using short tandem repeat. A pretransplant panel-reactive antibody was 47.5% with several HLA antibodies in higher titers. The patient received a brief course of steroids without any additional immunosuppressive agents after transplantation. Her postoperative course was uneventful without an episode of rejection or infection. The preformed HLA antibodies steadily declined over time after transplantation. At a 5-year follow-up, the patient achieved full enteral autonomy from parenteral nutrition with a regular lifestyle.
Identical-twin intestinal transplantation appears to provide the best outcomes by avoiding complications related to rejection and immunosuppression. We provide evidence that it may confer greater long-term immunological advantages even in a high-immunologic risk recipient.
拥有同卵双胞胎供体可避免与移植物排斥和免疫抑制相关的并发症，这是不可逆性肠衰竭的理想治疗选择。
我们描述了一名45岁女性，因急性肠系膜上动脉血栓形成失去了大部分小肠，接受了来自其同卵双胞胎姐妹的活体亲属小肠移植。通过使用短串联重复序列的颊黏膜涂片DNA扩增确定了单合子性。移植前群体反应性抗体为47.5%，几种HLA抗体滴度较高。患者移植后接受了短期类固醇治疗，未使用任何其他免疫抑制剂。她的术后过程平稳，没有排斥或感染事件。移植后预先形成的HLA抗体随时间稳步下降。在5年的随访中，患者通过规律的生活方式实现了完全肠内营养自主，不再依赖肠外营养。
同卵双胞胎肠移植似乎通过避免与排斥和免疫抑制相关的并发症而提供了最佳结果。我们提供的证据表明，即使在高免疫风险受者中，它也可能带来更大的长期免疫学优势。
