Lymphocyte markers and prediction of long-term renal allograft acceptance.

PURPOSE OF REVIEW: Long-term allograft acceptance is the main goal of posttransplant care. Modern immunosuppression has reduced the incidence of acute rejection, the major risk factor for long-term allograft survival, and improved the 1-year results, despite increasing use of marginal donor organs. However, the long-term results are still unsatisfactory. Chronic allograft injury and side effects of chronic immunosuppression are the main causes. Therefore, preemptive reduced long-term immunosuppression is required. Present 'trial-and-error' strategies appear to be remarkably harmful for patients not suitable for partial drug weaning. In addition, preemptive interventions have been shown to be the only successful strategy for improving the long-term transplant outcome in animal models. These findings underline the importance of early identification of biomarkers in detecting the individual's risk.

RECENT FINDINGS: Recent technological advances have provided evidence of successful approaches to this goal. A set of parameters/tests are showing promise for guiding personalized immunosuppression, including different technology platforms such as antidonor responsiveness/nonresponsiveness, cellular parameters predicting risk of virus-associated complications, gene expression analysis etc.

SUMMARY: Although the data are very promising, multicentric, prospective, randomized clinical trials are crucial prerequisites for introducing immune monitoring into routine clinical use. International networks, such as RISET and ITN, can help to facilitate this process.