Identical twin kidney transplants guarantee gene sequencing


Using data from the transplant registry in the United States, clinical researchers at the University of Pittsburgh School of Medicine discovered that kidney transplants between identical twins have high success rates, but also high rates of use of immunosuppressants.

Among 143 patients who received a kidney from their identical twin in the United States from 2001 to 2017, about half took immunosuppressive drugs a year after the operation. However, survival rates were practically the same, regardless of whether patients were taking immunosuppressants or not. Researchers propose guidelines for genetic testing and continuous management of identical twin transplants. The final version of the document was published today in American Journal of Transplantation.
"Once confirmed that the donor and the recipient of organs are identical, this is indeed an optimal scenario," said lead author Dana Jorgensen, Ph.D., M.P.H., epidemiologist at UPMC. "It's almost like getting a transplant from yourself because the fabric would be almost identical."
Twin transplants have a long history. In the 50s, before the age of the immunosuppressants, the doctors first tried kidney transplantation with identical twins because the chances of rejection are close to zero.

Then, the doctors would have grafted a piece of skin from one twin to the other to see if the twins were, in fact, a perfect combination before trying to transplant an entire organ. Today, gene sequencing allows doctors to tell with almost certainty whether a pair of twins is identical or not, and the researchers recommend using this test when preparing a transplant between identical suspect twins.

Although the researchers were surprised to see such a high rate of immunosuppressant use among the twins sampled for this study, Jorgensen pointed out that in many of these cases the doctor might not be sure that the twins were actually identical.

"One of the great things we noticed in the research of this is that the patient will think he is an identical twin, but they have never been tested, so they don't know for sure," Jorgensen said. "Maybe the doctors put these patients on immunosuppressants just in case."

Doctors also tend to use immunosuppressants for patients with glomerulonephritis – inflammation of the tiny kidney filters – due to fears that the disease would recur in the transplanted kidney. The study showed that the transplanted kidneys tended to get slightly worse in patients with glomerulonephritis, but there were not enough cases to draw conclusions about the benefits of immunosuppression for these patients.

The use of long-term immunosuppressants makes patients vulnerable to infections, cancer, diabetes and hypertension, so it is best to avoid them for identical twin transplants, if possible, said Sundaram Hariharan, MD, medical director of kidney and pancreas transplantation at UPMC, and senior author of the study.

"If you ask me, I feel very comfortable with retaining immunosuppressants from a patient who receives a kidney from an identical twin," said Hariharan, who is also a professor of medicine and Robert J. Corry, president of Surgery at Pitt. "Every transplant patient will be supervised to quickly detect potential organ rejection. They can be subjected to immunosuppressants later, if necessary. "

Christine Wu, M.D., of Pitt and UPMC also contributed to this document. None of the authors has financial information to report.

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