Immunological Monitoring in Kidney Transplantation

Abstract

Kidney transplantation is currently the best treatment for advanced chronic kidney disease. Improvements in pre-transplant immunological evaluation and the development of more potent immunossupressive drugs have considerably augmented short term allograft survival. Acute rejection rates have reached acceptable levels, even when transplantation is performed between HLA distinct individuals. Nonetheless, long term allograft survival remains suboptimal, due to various immunological and non-immunological factors. The chronic allograft dysfunc- tion can be caused either by an anti-allograft immune response of low intensity that “scapes” the immunosuppression or by an excessive im- munosuppression and its consequences, such as infections and nephrotoxicity. The alloimmune reactivity is a complex event that can vary over a wide range from rejection to tolerance. All this heterogeneity cannot be assessed by the diagnostic tools available nowadays. Thus, the development of reliable tests for monitoring alloimmune response during the post-transplantation period would allow early diagnosis of deleterious events and better individualization of immunosuppressive therapy.