Monitoring alloimmune response in kidney transplantation

Abstract

Currently, immunosuppressive therapy in kidney transplant recipients is generally performed by protocols and adjusted according to functional or histological evaluation of the allograft and/or signs of drug toxicity or infection. As a result, a large fraction of patients are likely to receive too much or too little immunosuppression, exposing them to higher rates of infection, malignancy and drug toxicity, or increased risk of acute and chronic graft injury from rejection, respectively. Developing reliable biomarkers is crucial for individualizing therapy aimed at extending allograft survival. Emerging data indicate that many assays, likely used in panels rather than single assays, have potential to be diagnostic and predictive of short and also long-term outcome. While numerous cross-sectional studies have found associations between the results of these assays and the presence of clinically relevant post-transplantation outcomes, data from prospective studies are still scanty, thereby preventing widespread implementation in the clinic. Of note, some prospective, randomized, multicenter biomarker-driven studies are currently on-going aiming at confirming such preliminary data. These works as well as other future studies are highly warranted to test the hypothesis that tailoring immunosuppression on the basis of results offered by these biomarkers leads to better outcomes than current standard clinical practice.

LCK as a Potential Therapeutic Target for Acute Rejection after Kidney Transplantation: A Bioinformatics Clue

“…AR in kidney transplantation is generally considered as an alloimmune response process involving networks of interacting cells throughout the body [ 22 ]. Our BP analysis showed that the mechanism of AR was primarily focused on immune process, and this finding is consistent with previous studies [ 6 , 23 ]. Then the CC ontology indicated that most of DEGs were membrane structures, such as proteins on integral component of membrane and plasma membrane.…”

Mechanisms of organ transplant injury mediated by B cells and antibodies: Implications for antibody-mediated rejection

“…Thus, the ability to quantify donor‐specific memory B cells in the clinical setting is critically needed, and a number of assays are currently being developed (reviewed in Ref. 40 ). Notably, the ability to quantify the frequency of all circulating memory B cells on the basis of the expression of CD27 and other markers, in pre‐ and posttransplant patients, represents a feasible approach but it is suboptimal, and an assay that quantifies the frequency of donor‐specific memory B cells will optimally identify patients with the potential of mounting a recall DSA response.…”

Seguimiento inmunológico después de trasplante renal: una propuesta para la práctica clínica en Colombia

“…La implementación de un protocolo de seguimiento del paciente con trasplante renal basado en criterios inmunológicos podría constituir una herramienta para la detección temprana del rechazo mediado por anticuerpos y, en consecuencia, para la implementación de estrategias de manejo que prevengan o demoren al máximo la aparición del rechazo crónico o la pérdida del órgano trasplantado 13 , 16 , 17 .…”