title: Calculated withdrawal of low-dose immunosuppression based on a detailed immunological monitoring after kidney transplantation between monocygotic twins.
abstract: BACKGROUND
  Pretransplant screening in living donor kidney transplantation includes human leukocyte antigen matching, and panel reactive antibody analysis, whereas T cell mediated anti-donor reactivity is not assessed routinely. We investigated T cell reactivity after living related kidney transplantation between two monocygotic twins and in consequence correlated the withdrawal of individual immunosuppressive medication with immunological findings.
  
  
  METHODS
  Immunosuppression consisted of mycophenolate mofetil, glucocorticoid single shot, and induction therapy with antithymocyte immunoglobulin.
  
  
  RESULTS
  FACS analysis of recipient peripheral blood cells revealed a normal haemogram after transplantation, showing non-activated CD4 and CD8 cells. Mixed lymphocyte reaction did not reveal donor-specific T cell activity. IFN-gamma and IL-10 ELISA of supernatants of recipient cells cocultivated with donor cells support the lack of Th1 and Th2 cell differentiation.
  
  
  CONCLUSIONS
  Based on immunological findings on days 5 and 20 MMF-therapy was reduced and stopped. Immunological monitoring on day 90 confirmed the absence of immune reactions directed against donor tissue.
authors.affiliation: Department of Surgery, Technische Universität München, D-81675 Munich, Germany. hueser@chir.med.tu-muenchen.de
authors.forename: Norbert
authors.initials: N
authors.lastname: Hüser
authors.forename: Edouard
authors.initials: E
authors.lastname: Matevossian
authors.forename: Patricia
authors.initials: P
authors.lastname: Schmidbauer
authors.forename: Volker
authors.initials: V
authors.lastname: Assfalg
authors.forename: Juergen E
authors.initials: JE
authors.lastname: Scherberich
authors.forename: Manfred
authors.initials: M
authors.lastname: Stangl
authors.forename: Bernhard
authors.initials: B
authors.lastname: Holzmann
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Melanie
authors.initials: M
authors.lastname: Laschinger
mesh_terms: D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000166:cytology; D001772:Blood Cell Count; D003404:Creatinine / Q000097:blood; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000276:immunology*; D007371:Interferon-gamma / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000276:immunology*; D007963:Leukocytes, Mononuclear / Q000166:cytology / Q000276:immunology; D007959:Lymphocyte Culture Test, Mixed; D015166:Monitoring, Immunologic; D009000:Monocytes / Q000166:cytology; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D016176:T-Lymphocyte Subsets / Q000166:cytology / Q000276:immunology; D018417:Th1 Cells / Q000276:immunology / Q000378:metabolism; D018418:Th2 Cells / Q000276:immunology / Q000378:metabolism; D014430:Twins, Monozygotic / Q000276:immunology*; D028761:Withholding Treatment
chemical_list: D000961:Antilymphocyte Serum; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016753:Interleukin-10; D007371:Interferon-gamma; D003404:Creatinine; D009173:Mycophenolic Acid