Calculated withdrawal of low-dose immunosuppression based on a detailed immunological monitoring after kidney transplantation between monocygotic twins.
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.
Hüser
Norbert
N
Department of Surgery, Technische Universität München, D-81675 Munich, Germany. hueser@chir.med.tu-muenchen.de
Matevossian
Edouard
E
Schmidbauer
Patricia
P
Assfalg
Volker
V
Scherberich
Juergen E
JE
Stangl
Manfred
M
Holzmann
Bernhard
B
Friess
Helmut
H
Laschinger
Melanie
M
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
D000961:Antilymphocyte Serum; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016753:Interleukin-10; D007371:Interferon-gamma; D003404:Creatinine; D009173:Mycophenolic Acid