Biomarkers of immune tolerance in kidney transplantation: an overview.
Wee Song YeoQin Xiang NgPublished in: Pediatric nephrology (Berlin, Germany) (2021)
Kidney failure, one of the most prevalent diseases in the world and with increasing incidence, is associated with substantial morbidity and mortality. Currently available modes of kidney replacement therapy include dialysis and kidney transplantation. Though kidney transplantation is the preferred and ideal mode of kidney replacement therapy, this modality, however, is not without its risks. Kidney transplant recipients are constantly at risk of complications associated with immunosuppression, namely, opportunistic infections (e.g., Epstein-Barr virus and cytomegalovirus infections), post-transplant lymphoproliferative disorder, and complications associated with immunosuppressants (e.g., calcineurin inhibitor- and corticosteroid-associated new onset diabetes after transplantation and calcineurin inhibitor-associated nephrotoxicity). Transplantation tolerance, an acquired state in which immunocompetent recipients have developed donor-specific unresponsiveness, may be the Holy Grail in enabling optimal allograft survival and obviating the risks associated with immunosuppression in kidney transplant recipients. This review aims to discuss the biomarkers available to predict, identify, and define the transplant immune tolerant state and various tolerance induction strategies. Regrettably, pediatric patients have not been included in any tolerance studies and this should be the focus of future studies.
Keyphrases
- kidney transplantation
- replacement therapy
- epstein barr virus
- smoking cessation
- diffuse large b cell lymphoma
- risk factors
- type diabetes
- cardiovascular disease
- human health
- chronic kidney disease
- stem cells
- cell therapy
- current status
- metabolic syndrome
- end stage renal disease
- risk assessment
- adipose tissue
- free survival
- glycemic control
- weight loss