Pretransplant immune risk assessment.
OBJECTIVE
Despite the introduction of advanced immunosuppressive drug therapies, clinical and subclinical rejections still occur in many graft recipients with a negative impact on the long-term transplant outcome. The immunological status of the patients awaiting the transplantation is a key factor for these processes. Here we summarize the recent efforts to identify and develop biomarkers and functional assays that allow an individual pretransplant risk assessment.


RESULTS
New sensitive techniques assessing T-cell memory and B-cell activation have been developed. Furthermore, the expression level of soluble and molecular markers reflecting the activation state of the immune system and donor graft intrinsic factors have been shown to influence graft outcome.


CONCLUSIONS
A variety of parameters and assays that determine the pretransplant immune activation status has been developed. Some of these assays have already been used prospectively to define high-risk patients receiving advanced immunosuppressive induction therapy.However, the conflicting results obtained in different studies show that biomarker analysis and functional assays performance need to be further standardized and validated in large prospective trials before they can be routinely implemented into a pretransplant risk assessment. Subsequently, a combined effort to design pretransplant risk stratification algorithms should lead to personalized immunosuppressive treatment regimes and improved graft survival and long-term graft function.
Sawitzki
Birgit
B
Institute of Medical Immunology, CCM, Germany. birgit.sawitzki@charite.de
Schlickeiser
Stephan
S
Reinke
Petra
P
Volk
Hans-Dieter
HD
D001402:B-Lymphocytes / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007156:Immunologic Memory; D007159:Immunologic Tests; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016377:Organ Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology
D015415:Biomarkers; D007166:Immunosuppressive Agents