Immune profiling and cancer post transplantation.

Area of Science:

• Nephrology
• Oncology
• Immunology

Background:

• Long-term kidney transplant recipients (KTR) have a high incidence of squamous cell carcinoma (SCC) and other cancers, which are leading causes of death.
• Pharmacological immunosuppression significantly contributes to increased cancer risk in KTR.
• Cancer lesions can exacerbate systemic immunosuppression in KTR.

Purpose of the Study:

• To review the rationale for post-transplant immune monitoring assays.
• To identify assays that can predict cancer and rejection in KTR.
• To explore the potential for immune monitoring to guide immunosuppression reduction.

Main Methods:

• Review of existing literature on immune monitoring in kidney transplant recipients.
• Analysis of assays measuring immunosuppressive drug levels, pharmacokinetics, and leukocyte function.
• Focus on assays correlating with cancer development and graft rejection.

Main Results:

• Immune monitoring can identify KTR at high risk for developing multiple SCC lesions.
• Evidence suggests that some KTR may benefit from reduced immunosuppressive drug doses.
• Assessing rejection risk is crucial before reducing immunosuppression.

Conclusions:

• Immune monitoring is valuable for managing cancer risk in KTR.
• Personalized immunosuppression management can potentially reduce cancer incidence.
• Balancing immunosuppression reduction with graft survival is paramount.