Testing the application of polygenic risk scores in the transplant setting – Relevance for precision medicine

[...]patients who are identified to be at risk for coronary heart disease, hypertension or diabetes using PRS at age of 25 would need a follow-up of 30 years to determine whether preemptive therapy impacts cumulative risk.1,2 THE ADVANTAGE OF STUDYING PRS IN THE TRANSPLANT SETTING The rapid development of metabolic syndrome complications in the transplant setting provides a more expedition and unique opportunity to test whether PRS can identify individuals at risk, set up preemptive protocols for the prevention of complications and determine whether changing the genetic environment via the introduction of the donor PRS can alter the clinical outcomes. Clinical studies using large databases demonstrated that within 12 months after transplantation, the incidence of new onset diabetes in all recipients is 15%–30%.3 Similar observations were reported for high prevalence soon after transplantation for hypertension, hyperlipidaemia and coronary heart disease.4–6 The ‘environmental variables’ that are responsible for a rapid development of these clinical complications are mainly the stress of surgery and the use of immunosuppressive drugs, many of which are known to be associated with the development of these chronic diseases (PMID: 32476781, PMID: 15093807). Knowing that immunosuppression drugs contribute significantly to these side effects, modifying immunosuppression protocols to use drug combinations and dosages that are tailored to each recipient may reduce the incidence of developing the complications. [...]it will allow more intense monitoring of recipient at the higher risk for early intervention.