Immunologic Risk Assessment before Kidney Transplantation: An Update

The most important kidney transplantation antigens are the ABO blood group antigens and the products of the major histocompatibility complex (MHC). The MHC antigens are called human leukocyte antigens (HLA). Exposure to foreign HLA through previous transplantations, blood transfusions and pregnancies are the most important risk factors for the development of anti-HLA antibodies. Along with improvements over the past 50 years in the detection of anti-HLA antibodies, one of the most important advances in facilitating transplantation of sensitized patients has been the ability to accurately characterize anti-HLA antibodies specificity using solid phase immunoassays. Cross-match testing with cytotoxic analysis has long been supplemented by flow cytometry, but development of solid-phase single antigen bead testing of solubilized HLA to detect donor-specific HLA antibodies (DSA) permits a far more nuanced stratification of immunological risk status, including the different classes and intensities of HLA antibodies class I and/or II, including HLA-DSA. Immunologic risk evaluation is now often based on a combination of all of these tests. In this process, the most important assistant of the clinician is an effective communication with the immunology team and the planning immunosuppressive treatment regimen should be decided according to pre-transplant immunologic risk levels. Cite this article as: Erdoğmuş Ş, Şengül Ş. Immunologic Risk Assessment before Kidney Transplantation: An Update. Turk J Nephrol 2019; 28(3): 216-24.