Calculated withdrawal of low-dose immunosuppression based on a detailed immunological monitoring after kidney transplantation between monocygotic twins

Transpl Immunol. 2009 Dec;22(1-2):38-43. doi: 10.1016/j.trim.2009.09.002. Epub 2009 Sep 17.

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.

Conclusion: 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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antilymphocyte Serum / administration & dosage
  • Antilymphocyte Serum / therapeutic use
  • B-Lymphocytes / cytology
  • Blood Cell Count
  • Creatinine / blood
  • Female
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / therapeutic use
  • Graft Survival / immunology
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / immunology*
  • Interferon-gamma / metabolism
  • Interleukin-10 / metabolism
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation / immunology*
  • Leukocytes, Mononuclear / cytology
  • Leukocytes, Mononuclear / immunology
  • Lymphocyte Culture Test, Mixed
  • Monitoring, Immunologic*
  • Monocytes / cytology
  • Mycophenolic Acid / administration & dosage
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • T-Lymphocyte Subsets / cytology
  • T-Lymphocyte Subsets / immunology
  • Th1 Cells / immunology
  • Th1 Cells / metabolism
  • Th2 Cells / immunology
  • Th2 Cells / metabolism
  • Twins, Monozygotic / immunology*
  • Withholding Treatment*

Substances

  • Antilymphocyte Serum
  • Glucocorticoids
  • Immunosuppressive Agents
  • Interleukin-10
  • Interferon-gamma
  • Creatinine
  • Mycophenolic Acid