Related Experiment Video
Updated: Feb 12, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Carpe diem-Time to transition from empiric to precision medicine in kidney transplantation
Chris Wiebe1,2, Julie Ho1,3, Ian W Gibson2,4
1Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Abstract:
The current immunosuppressive pipeline in kidney transplantation is limited. In part, this is due to excellent one-year allograft outcomes with the current standard of care (ie, calcineurin inhibitor in combination with anti-proliferative agents). Despite this success, a recent Federal government-sponsored systematic review has identified gaps/limits in the evidence of what constitutes optimal calcineurin inhibitor use in the short- and long-term. Moreover, recent empiric approaches to minimize/withdraw/convert from calcineurin inhibitors have come with the price of increased alloreactivity. As the time horizon to replace calcineurin inhibitors on a global scale may be distant, the transplant community should seize the opportunity to develop ways to personalize calcineurin inhibitor immunosuppression to the individual-transitioning from empiricism to precision. The authors argue in this viewpoint that the path to precision will require measures capable of detecting subclinical alloreactivity to define adequacy of immunosuppression, as well as novel genetic analytics to accurately define alloimmune risk at the individual level-both approaches will require validation in clinical trials.
Insights
Current kidney transplant immunosuppression has limits. Personalized calcineurin inhibitor therapy, using subclinical alloreactivity detection and genetic analytics, is proposed to improve long-term outcomes.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Current immunosuppressive regimens in kidney transplantation achieve good short-term outcomes but lack evidence for optimal long-term calcineurin inhibitor (CNI) use.
- Minimizing or withdrawing CNIs has led to increased alloreactivity, highlighting the need for refined strategies.
- The existing immunosuppressive pipeline offers limited alternatives to current standards of care.
Purpose of the Study:
- To advocate for a transition from empiric to precision-based immunosuppression in kidney transplantation.
- To propose methods for personalizing calcineurin inhibitor therapy based on individual patient risk and immune response.
Main Methods:
- This viewpoint discusses the need for novel approaches, including detecting subclinical alloreactivity.
- It highlights the potential of advanced genetic analytics to assess individual alloimmune risk.
- The authors emphasize the necessity of clinical trials for validating these precision strategies.
Main Results:
- Empiric CNI minimization strategies have shown increased alloreactivity.
- A clear need exists for better methods to define adequate immunosuppression.
- Personalized approaches are crucial for long-term allograft survival.
Conclusions:
- Precision immunosuppression in kidney transplantation requires validated methods to detect subclinical alloreactivity.
- Individualized alloimmune risk assessment through genetic analytics is essential.
- Clinical validation of these precision strategies is a critical next step for improving long-term transplant outcomes.
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