Twin-to-Twin Heart Transplantation: A Unique Event With a 25-Year Follow-Up

Blitzer, David; Yedlicka, Grace; Manghelli, Joshua L.; Dentel, John N.; Caldwell, Randall L.; Brown, John W.

doi:10.1016/j.athoracsur.2016.09.060

Cited by 7 publications

(6 citation statements)

References 6 publications

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“…Since the first successful kidney transplant performed on twins in 1954, the range of isogeneic transplants has expanded to include pancreas, liver, heart, small bowel, skin, rib cage, parathyroid, testicle, and lower extremity. 14 15 16 17 18 19 20 21 22 Compared to isogeneic solid organ transplants (SOTs), isogeneic soft tissue transplants are less frequently performed. Flap transplantation between monozygotic twins has been used for reconstruction of scalp, breast, and thoracic defects 2 3 4 5 6 7 8 ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

DIEP Flap Transplantation in Monozygotic Twins for Breast Reconstruction: A Case Report and Literature Review

Öztürk

Manisundaram

Rivera

et al. 2023

J Reconstr Microsurg Open

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Background: Composite tissue allotransplants are performed for various defects when local, or distant reconstructive options are limited. Though this type of transplant replaces similar tissue, it is complicated by immunosuppression. This limitation may be avoided in monozygotic twins since they share identical genetic code. Free soft tissue transplantation across identical twins has been reported for breast, scalp, and thoracic reconstruction when autologous tissues were insufficient. We present a case of a successful DIEP flap transplantation in monozygotic twins. Methods: The recipient twin was a patient with history of breast cancer and failed prosthetic reconstruction. She desired autologous reconstruction with a DIEP flap but had insufficient donor tissue. She refused alternative sites; however, she had an identical twin willing to donate her excess abdominal tissue. The twins underwent DNA testing, HLA/blood type testing, and screening for communicable diseases. Results: The twins were found to have greater than 99.99% probability of being monozygotic twins. A bipedicled conjoined DIEP was harvested from donor twin and transplanted to recipient twin. Immunosuppressive regimen was not utilized. Patients healed uneventfully and are currently 5 years postop without long term complications. Conclusion: Isogeneic flap transplant is a viable option to consider when autologous tissues are restricted, and monozygotic twins are present. Appropriate counseling of twins is critical for a successful and satisfactory outcome.

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Section: Discussionmentioning

confidence: 99%

DIEP Flap Transplantation in Monozygotic Twins for Breast Reconstruction: A Case Report and Literature Review

Öztürk

Manisundaram

Rivera

et al. 2023

J Reconstr Microsurg Open

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“…Two dizygotic twins were delivered using emergency caesarean section due to fetal distress. 76 One twin was born with a previously undiagnosed hypoplastic left heart syndrome…”

Section: Heartmentioning

confidence: 99%

“…In an article published in 2017, Blitzer et al describe a unique occurrence from 1991. Two dizygotic twins were delivered using emergency caesarean section due to fetal distress 76 . One twin was born with a previously undiagnosed hypoplastic left heart syndrome requiring a heart transplant.…”

Section: Introductionmentioning

confidence: 99%

Potential of neonatal organ donation and outcome after transplantation

Bluhme

Henckel

Jorns

2023

Pediatric Transplantation

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Organ transplantation is limited by access to suitable organs. Infant recipient waitlist mortality is increased due to the scarcity of size‐matched organs. Neonatal organ donors have been proposed as an underutilized source of donor organs. However, the literature on the actual prevalence and outcome of neonatal organ donation and transplantation is fragmented and not well analyzed. This literature review aims to summarize the available literature on the potential of neonatal organ donation and to analyze published cases of neonatal organ transplantation. A systematic search of the Medline and Cochrane databases yielded 2964 articles, which were screened for eligibility. In total, 86 articles were considered eligible, of which 34 were included in the literature review: 8 articles describing the potential of neonatal organ donation programs, and 26 articles describing clinical transplantation. Current evidence suggests there is a large pool of potential neonatal organ donors. In contrast, the literature on neonatal organ donor utilization is sparse. However, case series of successful kidney, heart, liver, hepatocyte, and multivisceral transplantation using organs from neonatal donors are summarized. Although good posttransplant organ function was achieved, the use of neonatal organs is associated with increased risk of thrombosis in both kidney and liver transplantation. Neonatal organ donation is a promising alternative for expanding the current donor pool. Experience is limited, but reported patient and graft survival are acceptable and more research on the subject is warranted.

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“…This is also clinically evident from the realization that the longevity of conjoined homozygous twins remains unchallenged, at least from an immunological perspective. The approach is understandably cautious when transplantation of solid organs is performed between dizygotic twins or between closely matched individuals despite zero-HLA-mismatch, with low-level immunosuppressive regimens still being advocated ( 52 ), although successful outcomes following renal transplantation between homozygous pairs have been reported without continuous immunotherapy ( 53 , 54 ), but long-term studies are lacking.…”

Section: Immunogenicity and Phylogenetic Disparitymentioning

confidence: 99%

Residual Bioprosthetic Valve Immunogenicity: Forgotten, Not Lost

Human

Bezuidenhout

Aïkawa

et al. 2022

Front. Cardiovasc. Med.

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Despite early realization of the need to control inherent immunogenicity of bioprosthetic replacement heart valves and thereby mitigate the ensuing host response and its associated pathology, including dystrophic calcification, the problem remains unresolved to this day. Concerns over mechanical stiffness associated with prerequisite high cross-link density to effect abrogation of this response, together with the insinuated role of leaching glutaraldehyde monomer in subsequent dystrophic mineralization, have understandably introduced compromises. These have become so entrenched as a benchmark standard that residual immunogenicity of the extracellular matrix has seemingly been relegated to a very subordinate role. Instead, focus has shifted toward the removal of cellular compartment antigens renowned for their implication in the failure of vascularized organ xenotransplants. While decellularization certainly offers advantages, this review aims to refocus attention on the unresolved matter of the host response to the extracellular matrix. Furthermore, by implicating remnant immune and inflammatory processes to bioprosthetic valve pathology, including pannus overgrowth and mineralization, the validity of a preeminent focus on decellularization, in the context of inefficient antigen and possible residual microbial remnant removal, is questioned.

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Twin-to-Twin Heart Transplantation: A Unique Event With a 25-Year Follow-Up

Cited by 7 publications

References 6 publications

DIEP Flap Transplantation in Monozygotic Twins for Breast Reconstruction: A Case Report and Literature Review

DIEP Flap Transplantation in Monozygotic Twins for Breast Reconstruction: A Case Report and Literature Review

Potential of neonatal organ donation and outcome after transplantation

Residual Bioprosthetic Valve Immunogenicity: Forgotten, Not Lost

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