Are we Winning at Twinning? Immunosuppression and Rejection in Identical Twin Kidney Transplants
Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Nicholas Herrera
Presentation Type
Poster
Start Date
19-5-2026 12:00 PM
End Date
19-5-2026 1:00 PM
Abstract Text
Purpose
This study aims to describe immunosuppression trends and all-cause rejection rates at 1-year post-transplant in syngeneic kidney transplants.
Methods
Utilizing SRTR data collected from January 1, 2014, to October 1, 2023, we conducted a retrospective analysis utilizing R programming language. Stepwise exclusion criteria detailed in Figure 1 were applied to identify living syngeneic (identical twin) kidney donor-recipient pairs. Demographic characteristics, immunosuppression regimens, and all-cause rejection outcomes for these pairs were examined.
Results
During the study period, 65 patients received allografts from syngeneic (identical twin) donors. Recipient demographics are summarized in Table 1. The mean cPRA was 8.65%, and the average cold ischemia time was 1.54 hours. Of the 65 recipients, six received thymoglobulin for induction; only one of these had a cPRA above 30%. At the time of discharge, one patient was not on maintenance immunosuppression, ten were on steroids alone, and 43 (66.2%) were on calcineurin inhibitors (CNI). Thirty-two patients had end-stage renal disease (ESRD) secondary to glomerulonephritis; all but one were discharged on steroids. Thirty-eight recipients (58.5%) received triple immunosuppression at discharge, five of whom had a cPRA above 30% (range: 0-89.67%). Notably, zero instances of rejection occurred within one-year post-discharge among this cohort.
Conclusion
Syngeneic transplant from an identical twin presents a unique opportunity to reduce exposure to immunosuppressive medications and minimize associated side effects.
However, the data presented demonstrate a continued tendency to prescribe lymphocyte-depleting induction therapies and triple immunosuppression, including nephrotoxic calcineurin inhibitors (CNI), even in patients with comorbidities such as hypertension and diabetes mellitus. Encouraged by the absence of all-cause rejection at one-year post-transplant, we advocate for reducing immunosuppression both at induction and during maintenance, tailored to patient-specific indications.
Are we Winning at Twinning? Immunosuppression and Rejection in Identical Twin Kidney Transplants
Purpose
This study aims to describe immunosuppression trends and all-cause rejection rates at 1-year post-transplant in syngeneic kidney transplants.
Methods
Utilizing SRTR data collected from January 1, 2014, to October 1, 2023, we conducted a retrospective analysis utilizing R programming language. Stepwise exclusion criteria detailed in Figure 1 were applied to identify living syngeneic (identical twin) kidney donor-recipient pairs. Demographic characteristics, immunosuppression regimens, and all-cause rejection outcomes for these pairs were examined.
Results
During the study period, 65 patients received allografts from syngeneic (identical twin) donors. Recipient demographics are summarized in Table 1. The mean cPRA was 8.65%, and the average cold ischemia time was 1.54 hours. Of the 65 recipients, six received thymoglobulin for induction; only one of these had a cPRA above 30%. At the time of discharge, one patient was not on maintenance immunosuppression, ten were on steroids alone, and 43 (66.2%) were on calcineurin inhibitors (CNI). Thirty-two patients had end-stage renal disease (ESRD) secondary to glomerulonephritis; all but one were discharged on steroids. Thirty-eight recipients (58.5%) received triple immunosuppression at discharge, five of whom had a cPRA above 30% (range: 0-89.67%). Notably, zero instances of rejection occurred within one-year post-discharge among this cohort.
Conclusion
Syngeneic transplant from an identical twin presents a unique opportunity to reduce exposure to immunosuppressive medications and minimize associated side effects.
However, the data presented demonstrate a continued tendency to prescribe lymphocyte-depleting induction therapies and triple immunosuppression, including nephrotoxic calcineurin inhibitors (CNI), even in patients with comorbidities such as hypertension and diabetes mellitus. Encouraged by the absence of all-cause rejection at one-year post-transplant, we advocate for reducing immunosuppression both at induction and during maintenance, tailored to patient-specific indications.
Comments
Restricted to Title/Author List/Abstract only as requested by primary author
Poster Board Number: 22