organs imported from a non-local Organ Procurement Organization. Virtual crossmatch (VXM) allows for rapid assessment of donorrecipient compatibility by comparing donor and recipient human leukocyte antigen (HLA) information. VXM has the potential to decrease CIT in DDKT, which will reduce delayed graft function rates and improve transplant outcomes. Reducing false positive XM and CIT could also reduce organ discard and improve organ utilization. Specific aims of Dr. Puttarajappa’s research are: 1) Evaluate the current crossmatch practices in DDKT among different donor and recipient subgroups, along with assessing perceptions of transplant professionals regarding VXM; 2) Explore whether the use of VXM is associated with lower CIT and DGF, and whether this is different before and after the introduction of KAS; and 3) Explore whether routine application of VXM prior to DDKT has the potential to improve patient outcomes. Dr. Puttarajappa’s research aims to identify situations in DDKT where a VXM alone can be used to safely proceed to transplantation without a physical XM. Modeling results will aim to quantify risks and benefits of omitting a physical XM in specific scenarios that differ in key patient and immunological risk categories. Additionally, findings on national crossmatch practice variation and perceptions of the transplant community towards VXM will help direct future research, changes to histocompatibility testing protocols, and health policy surrounding kidney transplantation. Dr. Puttarajappa will be mentored in his research by kidney transplant outcomes research expert Sundaram Hariharan, MD; mathematical modeling and decision analysis experts Kenneth Smith, MD, MS, and Mark Roberts, MD, MPP; and survey methodology and donor research mentor Howard Degenholtz, PhD. UPMC Physician Resources For the latest news, events, videos, and free CME courses presented by UPMC clinicians and researchers, visit UPMCPhysicianResources.com/Kidney. Current CME Courses Include: Preventing the “Crash”: The Internist’s Guide to Managing Advanced Stage Kidney Disease Presented by James R. Johnston, MD High Risk Kidney Donor: New Paradigms in Transplantation Presented by Amit D. Tevar, MD, FACS Is My Patient a Candidate? Advanced Age/Frailty, Obesity, Recurrent Disease, Malignancy, Noncompliance, Advanced CV Comorbidity Presented by Christine Wu, MD BKV, CMV, and EVB (PTLD): Bench to Bedside Updates Presented by Chethan Puttarajappa, MD, MS Updates in Diagnosis and Management of Rejection in Renal Transplantation Presented by Rajil Mehta, MD, FASN Disorders of Sodium and Potassium in the Elderly Presented by James R. Johnston, MD Kidney Transplantation for the Pediatric Patient Presented by Armando Ganoza, MD Video Rounds Video Rounds is a series of short, informative, and educational videos created for physicians and covering a variety of medical and surgical disciplines. Current topics in nephrology and kidney transplantation include: Hyponatremia Treatment – Helbert Rondon, MD Renal Palliative Care – Jane Schell, MD Kidney Transplantation – Sundaram Hariharan, MD Acute Kidney Injury and Critical Care Nephrology – John Kellum, MD Evaluating Medications That Induce Hyperkalemia – Thomas Kleyman, MD | 7 | RENAL-ELECTROLYTE DIVISION | WINTER 2020 Identical Twin Kidney Transplants Warrant Gene Sequencing Using U.S. transplant registry data, clinical researchers at the University of Pittsburgh School of Medicine found that kidney transplants between identical twins have high success rates, but also high rates of immunosuppressant use. Among 143 patients who received a kidney from their identical twin in the U.S. from 2001 to 2017, about half were on immunosuppressant drugs a year after the operation. Yet, survival rates were about the same regardless of whether patients were on immunosuppressants or not. The researchers propose guidelines for genetic testing and continued management of identical twin transplants. The paper1 was published in the American Journal of Transplantation in October, 2019. “Once you confirm that the organ donor and recipient are identical, that’s really a best-case scenario,” says lead author Dana Jorgensen, PhD, MPH, an epidemiologist at UPMC. “It’s almost like getting a transplant from yourself because the tissue would be almost identical.” Twin transplants have a long history. In the 1950s, before the age of immunosuppressants, doctors tried kidney transplantation first with identical twins because the odds of rejection are close to zero. Back then, doctors would graft a piece of skin from one twin to another to see whether the twins were, indeed, a perfect match before attempting to transplant a whole organ. Today, gene sequencing allows physicians to say with near certainty whether a pair of twins is identical or not, and the researchers recommend using this test when preparing a transplant between suspected identical 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 physician may not have been confident that the twins were actually identical. “One of the big things we noticed in researching this is that the