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.
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.
/ Public publication. View in full Here.