{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:20:02Z","timestamp":1787682002352,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Calcineurin inhibitors (CNIs) revolutionized kidney transplantation by reducing acute rejection rates. Identical twin kidney transplantation is the only setting in which the allograft is immunologically indistinguishable from self, yet CNI use persists. We characterized CNI utilization across end\u2010stage kidney disease etiologies and examined whether CNI exposure was associated with reduced rejection or improved death\u2010censored graft survival (DCGS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study using scientific registry of transplant recipients data (January 2000\u2013August 2025). Among 255 adult identical twin kidney transplant recipients, discharge regimens were categorized by CNI use; Firth penalized Cox regression was the primary method for 10\u2010year DCGS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among recipients, 129 (50.6%) received a CNI at discharge with no decline over 25 years and use across every etiology, including glomerulonephritis (53.6%), cystic disease (80.0%), diabetes (51.8%), and hypertension (50.0%), several of which carry no recurrence or immunologic rationale. No biopsy\u2011proven rejections occurred within the first year. CNI use was not associated with improved DCGS in the full cohort (HR, 1.67; 95% CI, 0.72\u20134.13;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.234) or the glomerulonephritis subgroup (log\u2010rank\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.582).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Half of U.S. identical twin kidney transplant recipients receive CNIs at discharge, with no utilization decline over 25 years. This practice is not supported by measurable reductions in rejection or improved graft survival and warrants clinical re\u2010evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70661","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T12:47:31Z","timestamp":1787662051000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Are We Winning at Twinning? Persistent CNI Use in Identical Kidney Transplants"],"prefix":"10.1111","volume":"40","author":[{"given":"Nicholas S.","family":"Herrera","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine University of Kansas Medical Center  Kansas City Kansas USA"},{"name":"Division of Nephrology, Department of Pediatrics Children's Mercy Kansas City  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivani","family":"Wadnerkar","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Pediatrics Children's Mercy Kansas City  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane M.","family":"Cibrik","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.05021107"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1956.02960390027008"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20106143.2008.02378.x"},{"key":"e_1_2_10_5_1","volume-title":"An Atlas of Multiple Pregnancy: Biology and Pathology","author":"Machin G. 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