Believing in the Nobel Prize: Long-term Success After HLA-Identical Kidney Transplantation in 3 Monozygotic Twins Without any Induction or Maintenance Immunosuppression

Background. Kidney transplantation between HLA-identical monozygotic twins offers a unique chance for long-term graft survival without immunosuppression. Although favorable outcomes after withdrawal of maintenance immunosuppression have been reported, complete omission remains uncommon, and immunosuppressive strategies are not standardized across centers. Methods. We report 3 HLA-identical monozygotic twin pairs who underwent kidney transplantation without induction or maintenance immunosuppression. Allograft function was monitored longitudinally, with follow-up durations of 22, 10, and 4 y, respectively. All patients had immediate and sustained excellent graft function with no rejection episodes or native disease recurrence during follow-up. Results. Patient 1 was a 29-y-old man with chronic glomerulonephritis and had a largely uneventful course posttransplant. Patient 2 was a 61-y-old man who received his third graft from his monozygotic twin. Although highly sensitized because of previous transplants (calculated panel-reactive antibody = 62%), no desensitization or immunosuppressive therapy was administered, and graft function remained excellent without rejection. Patient 3 was a 43-y-old woman with IgA nephropathy, who was transplanted in high-risk cytomegalovirus constellation (donor +/recipient –). She developed a primary cytomegalovirus infection after cessation of 3-mo prophylaxis, which was successfully treated with valganciclovir. Conclusions. This case series demonstrates that kidney transplantation between HLA-identical monozygotic twins can achieve excellent long-term graft survival without any induction or maintenance immunosuppression.