Urological Survey Renal Transplantation and Renovascular Hypertension Re: Transplantation between Monozygotic Twins: How Identical are They? E. Day, P. K. Kearns, C. J. Taylor and J. A. Bradley Department of Surgery, Southern General Hospital, Glasgow, and Histocompatibility and Immunogenetics Laboratory, Cambridge University Teaching Hospitals NHS Foundation Trust and Department of Surgery, University of Cambridge Clinical School, Addenbrooke’s Hospital and NIHR Biomedical Research Centre, Cambridge, United Kingdom Transplantation 2014; 98: 485e489.
Abstract available at http://jurology.com/ Editorial Comment: I found this article interesting because it identifies several mechanisms for phenotypic variation among monozygotic (MZ) twins. The authors describe somatic mosaicism, chimerism and epigenetic drift as ways to explain phenotypic differences that may be present between MZ twins. It is unclear how these factors may affect immune responses. Zygosity testing has largely replaced reverse skin grafting for assessment of MZ twins. The authors recommend early use of immunosupression in MZ transplantation, surrounding the early inflammatory response postoperatively. This application can be followed by cautious reduction/elimination of immunosupression. The main point is that MZ twins “may not be as identical as once believed.” David A. Goldfarb, MD