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Lack of an accepted definition for 'high immunological risk' hampers individualization of immunosuppressive therapy after kidney transplantation. For recipient-related risk factors for acute rejection, the most compelling evidence points to younger age and African American ethnicity. Recipient gender, body mass, previous transplantation, and concomitant infection or disease do not appear to be influential. Deceased donation now has only a minor effect on rejection risk, but older donor age remains a significant predictor. Conventional immunological markers (human leukocyte antigen [HLA] mismatching, pretransplant anti-HLA alloantibodies, and panel reactive antibodies) are being reassessed in light of growing understanding about the role of donor-specific antibodies (DSA). At the time of transplant, delayed graft function is one of the most clear-cut risk factors for acute rejection. Extended cold ischemia time (≥ 24 h) may also play a contributory role. While it is not yet possible to establish conclusively the relative contribution of different risk factors for acute rejection after kidney transplantation, the available data point to variables that should be taken into account at the time of transplant. Together, these offer a realistic basis for planning an appropriate immunosuppression regimen in individual patients.

Original publication

DOI

10.1111/tri.12205

Type

Journal article

Journal

Transpl Int

Publication Date

02/2014

Volume

27

Pages

129 - 138

Keywords

acute rejection, donor, high risk, immunological, recipient, risk factors, African Americans, Body Mass Index, Cold Temperature, Delayed Graft Function, Female, Graft Rejection, Graft Survival, HLA Antigens, Humans, Immunosuppression, Immunosuppressive Agents, Ischemia, Isoantibodies, Kidney Transplantation, Male, Multivariate Analysis, Patient Compliance, Risk Factors, Time Factors