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Monitoring alloimmune response in kidney transplantation
Oriol Bestard1, Paolo Cravedi2
1Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona University, IDIBELL, Barcelona, Spain.
Abstract:
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.
Insights
Developing reliable biomarkers is crucial for personalizing immunosuppressive therapy in kidney transplant recipients. Biomarker-driven studies aim to optimize immunosuppression, reducing infection, malignancy, and graft rejection risks.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Current immunosuppressive therapy for kidney transplant recipients relies on standard protocols.
- This approach often leads to suboptimal immunosuppression, increasing risks of infection, malignancy, drug toxicity, or graft rejection.
- Individualized therapy using reliable biomarkers is needed to improve allograft survival.
Purpose of the Study:
- To highlight the potential of biomarkers in personalizing immunosuppressive therapy for kidney transplant recipients.
- To emphasize the need for prospective studies to validate biomarker utility.
- To support the development of biomarker-guided protocols for improved patient outcomes.
Main Methods:
- Review of emerging data on biomarker assays for post-transplantation outcomes.
- Analysis of associations found in cross-sectional studies.
- Consideration of ongoing prospective, randomized, multicenter biomarker-driven studies.
Main Results:
- Numerous assays show potential for diagnosing and predicting short- and long-term outcomes.
- Cross-sectional studies suggest associations between biomarkers and clinical outcomes.
- Prospective data are still limited, hindering widespread clinical implementation.
Conclusions:
- Biomarker panels show promise for tailoring immunosuppression in kidney transplant recipients.
- Prospective studies are essential to confirm the predictive value of biomarkers.
- Biomarker-guided immunosuppression may lead to better allograft survival compared to standard protocols.
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