title: Transplantation between monozygotic twins: how identical are they?
abstract: Advances in developmental biology have shown that monozygous twins may not be as phenotypically identical as once believed, and the mechanisms responsible for such differences are now becoming clearer. Whether such phenotypic differences are capable of triggering graft rejection of an organ transplanted between identical twins remains unknown but the risks seem low, and long-term transplant outcome is excellent. Available evidence to guide immunosuppressive therapy in this setting is limited but a prudent approach would include the use of steroids together with a calcineurin inhibitor after transplantation. However, once the inevitable inflammatory response associated with transplant surgery has resolved, cautious reduction and eventually withdrawal of immunosuppression should be possible.
authors.affiliation: 1 Department of Surgery, Southern General Hospital, Glasgow, United Kingdom. 2 Histocompatibility and Immunogenetics Laboratory, Cambridge University Teaching Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom. 3 NIHR Biomedical Research Centre, Cambridge, United Kingdom. 4 Department of Surgery, University of Cambridge Clinical School, Addenbrooke's Hospital, Cambridge, United Kingdom. 5 Address correspondence to: Elizabeth Day, Ph.D., Department of Surgery, Southern General Hospital, Glasgow, Lanarkshire, G51 4TF, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Day
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Kearns
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Taylor
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bradley
mesh_terms: D046528:Chimerism; D044127:Epigenesis, Genetic; D006084:Graft Rejection / Q000235:genetics / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000235:genetics* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D009030:Mosaicism; D010641:Phenotype; D014430:Twins, Monozygotic / Q000235:genetics*
chemical_list: D007166:Immunosuppressive Agents