Trasplante renal de donante vivo entre gemelos monocigotos sin inmunosupresión de mantenimiento

Ana Sánchez-Escuredo, Alberto Barajas, Ignacio Revuelta, Miquel Blasco, Federic Cofan, Núria Esforzado, María José Ricart, Vicens Torregrosa, Josep Maria Campistol, Federic Oppenheimer, Fritz Diekmann

In spite of the fact that, from a theoretical point of view, an alloimmune response is not possible, some kind of standard immunosuppression is used in about 60% of patients receiving kidney grafts from their monozygotic twins. We aimed at assessing clinical response in patients receiving renal grafts from a living monozygotic twin donor when no immunosuppressive therapy is used. A retrospective observational study of patients receiving kidney grafts from their monozygotic twins from 1969 to 2013. The following data were recorded: age, renal graft recipient's primary disease, renal function, renal survival and overall survival. Immunosuppressive therapy included a single intraoperative dose of methylprednisolone 500mg and no maintenance immunosuppression. Five patients having received kidney grafts from their monozygotic twins were found in our centre. Mean age at transplantation was 33 years (27-39). One-year overall survival and graft survival were 100%. Mean creatinine level was 0.96±0.2 one year after transplantation, and 1.2±0.37mg/dl at most recent follow-up. Two patients died with a functional graft more than 15 years after kidney transplantation (causes were one each of melanoma and cardiovascular event). Follow-up was lost in a patient one year after transplantation. Two patients are alive with a functioning graft at 18 months and 42.5 years after transplantation, respectively. Kidney transplantation from a living monozygotic twin is associated to outstanding clinical outcomes. Immunossuppresive therapy to suppress alloimmune response in probably unnecessary 11 zygosity has been confirmed.