Successful Double DIEP Syngeneic Transplantation across Monozygotic Twins for Total Back Reconstruction
Jesse C Selber1, Lionel Kameni1, Keila Torres1
1From The University of Texas M. D. Anderson Cancer Center; and Houston Methodist Hospital.
Plastic and Reconstructive Surgery
|October 27, 2021
Summary
This case study details a successful vascularized composite allotransplantation between identical twins for recurrent cancer. The 10/10 human leukocyte antigen match eliminated the need for immunosuppression, demonstrating oncologic safety in this unique procedure.
Area of Science:
- Reconstructive surgery
- Transplantation immunology
- Oncology
Background:
- A patient with extensive sarcoma requiring back resection had limited autologous donor sites.
- A significantly larger identical twin was available as a donor.
- Cancer is a traditional contraindication for vascularized composite allotransplantation, but monozygotic twins offer a unique opportunity to avoid immunosuppression.
Observation:
- Preoperative genetic analysis confirmed 10/10 human leukocyte antigen homozygosity between the twins.
- Despite phenotypic differences, the sisters were genotypically identical.
- A two-stage deep inferior epigastric perforator transplant was performed, including an arteriovenous loop and bilateral lumbar artery perforator flaps.
Findings:
- The sarcoma resection yielded a large specimen (22 × 29 cm).
- The transplant was successfully performed between the twins with two arteries and six veins anastomosed.
- No rejection or flap compromise was observed at over 36 months post-transplant.
Implications:
- This is a rare vascularized composite allotransplantation between monozygotic twins and the first for recurrent cancer.
- Achieving 100% histocompatibility in identical twins is crucial for oncologic safety, potentially avoiding immunosuppression.
- This procedure highlights the feasibility of allotransplantation in cases with limited autologous options and significant size discrepancies.
