Kidney transplantation in identical twins: the state of art and a case report

Abstract

Kidney transplantation among two identical twins precludes graft rejection. Despite this fact, according to recent reports, more than 70% of recipients received immunosuppression at the discharge and 33% therapy was continued a year after transplant. The key issues in planning a renal transplant from twins are confirmation of monozygosity, risk assessment for the donor and choice of immunosuppressive strategy. Same date of birth, gender, identical blood groups, and A-, B- DR- HLA antigens are mandatory, but insufficient to confirm monozygosity when planning transplantation. All of the above with a 16% probability may correspond to dizygotic twins. A type of DNA polymorphism consisted of tandemly arranged blocks of 2 to 10 nucleotides with a high level of heterozygosity, is widespread in the human genome. They are easy to genotype, and the identity of their variants in two twins proves monozygosity. In the presented case, before minimizing and further discontinuation of immunosuppression, donor and recipient were analyzed for short tandem DNA repeats. 1.5 years after transplant, of which the recipient does not receive immunosuppression for the last 9 months, the graft function is stable and there are no laboratory signs of rejection or IgA-nephropathy recurrence.