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2017 ; 30
(2
): 187-200
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Monitoring alloimmune response in kidney transplantation
#MMPMID27245689
Bestard O
; Cravedi P
J Nephrol
2017[Apr]; 30
(2
): 187-200
PMID27245689
show ga
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.
|*Transplantation Tolerance/drug effects
[MESH]
|B-Lymphocytes/drug effects/immunology
[MESH]
|Biomarkers/blood
[MESH]
|DNA/genetics
[MESH]
|Drug Monitoring/*methods
[MESH]
|Enzyme-Linked Immunospot Assay
[MESH]
|Flow Cytometry
[MESH]
|Graft Rejection/blood/diagnosis/immunology/*prevention & control
[MESH]
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