Identical Twin Small-bowel Transplantation Without Maintenance Immunosuppression: A 5-year Follow-up and Literature Review
Background. 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. Methods and Results. We described a 45-year-old woman who lost most of her small b...
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doaj-c73349053bd2471aa796ccc7f9818cae2020-11-25T00:01:47ZengWolters KluwerTransplantation Direct2373-87312018-08-0148e37410.1097/TXD.0000000000000807201808000-0008Identical Twin Small-bowel Transplantation Without Maintenance Immunosuppression: A 5-year Follow-up and Literature ReviewGuosheng Wu, MD, PhD0Qingchuan Zhao, MD, PhD1Mian Wang, MD2Jiangpeng Wei, MD3Hao Sun, MD4Jianyong Zheng, MD5Daiming Fan, MD, PhD61 Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.1 Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.1 Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.1 Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.1 Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.1 Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.1 Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.Background. 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. Methods and Results. 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. Conclusions. 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.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000807 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Guosheng Wu, MD, PhD Qingchuan Zhao, MD, PhD Mian Wang, MD Jiangpeng Wei, MD Hao Sun, MD Jianyong Zheng, MD Daiming Fan, MD, PhD |
spellingShingle |
Guosheng Wu, MD, PhD Qingchuan Zhao, MD, PhD Mian Wang, MD Jiangpeng Wei, MD Hao Sun, MD Jianyong Zheng, MD Daiming Fan, MD, PhD Identical Twin Small-bowel Transplantation Without Maintenance Immunosuppression: A 5-year Follow-up and Literature Review Transplantation Direct |
author_facet |
Guosheng Wu, MD, PhD Qingchuan Zhao, MD, PhD Mian Wang, MD Jiangpeng Wei, MD Hao Sun, MD Jianyong Zheng, MD Daiming Fan, MD, PhD |
author_sort |
Guosheng Wu, MD, PhD |
title |
Identical Twin Small-bowel Transplantation Without Maintenance Immunosuppression: A 5-year Follow-up and Literature Review |
title_short |
Identical Twin Small-bowel Transplantation Without Maintenance Immunosuppression: A 5-year Follow-up and Literature Review |
title_full |
Identical Twin Small-bowel Transplantation Without Maintenance Immunosuppression: A 5-year Follow-up and Literature Review |
title_fullStr |
Identical Twin Small-bowel Transplantation Without Maintenance Immunosuppression: A 5-year Follow-up and Literature Review |
title_full_unstemmed |
Identical Twin Small-bowel Transplantation Without Maintenance Immunosuppression: A 5-year Follow-up and Literature Review |
title_sort |
identical twin small-bowel transplantation without maintenance immunosuppression: a 5-year follow-up and literature review |
publisher |
Wolters Kluwer |
series |
Transplantation Direct |
issn |
2373-8731 |
publishDate |
2018-08-01 |
description |
Background. 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.
Methods and Results. 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.
Conclusions. 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. |
url |
http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000807 |
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