Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Sep 13;12(18):5938.
doi: 10.3390/jcm12185938.

Preventing Rejection of the Kidney Transplant

Divyanshu Malhotra  1 , Priyanka Jethwani  2
Affiliations
Review

Preventing Rejection of the Kidney Transplant

Divyanshu Malhotra et al. J Clin Med. .

Abstract

With increasing knowledge of immunologic factors and with the advent of potent immunosuppressive agents, the last several decades have seen significantly improved kidney allograft survival. However, despite overall improved short to medium-term allograft survival, long-term allograft outcomes remain unsatisfactory. A large body of literature implicates acute and chronic rejection as independent risk factors for graft loss. In this article, we review measures taken at various stages in the kidney transplant process to minimize the risk of rejection. In the pre-transplant phase, it is imperative to minimize the risk of sensitization, aim for better HLA matching including eplet matching and use desensitization in carefully selected high-risk patients. The peri-transplant phase involves strategies to minimize cold ischemia times, individualize induction immunosuppression and make all efforts for better HLA matching. In the post-transplant phase, the focus should move towards individualizing maintenance immunosuppression and using innovative strategies to increase compliance. Acute rejection episodes are risk factors for significant graft injury and development of chronic rejection thus one should strive for early detection and aggressive treatment. Monitoring for DSA development, especially in high-risk populations, should be made part of transplant follow-up protocols. A host of new biomarkers are now commercially available, and these should be used for early detection of rejection, immunosuppression modulation, prevention of unnecessary biopsies and monitoring response to rejection treatment. There is a strong push needed for the development of new drugs, especially for the management of chronic or resistant rejections, to prolong graft survival. Prevention of rejection is key for the longevity of kidney allografts. This requires a multipronged approach and significant effort on the part of the recipients and transplant centers.

Keywords: HLA matching; biomarkers; desensitization; emerging therapies; immunosuppression; preventing rejection.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prevention of rejection.
Figure 2
Figure 2
Post-transplant measures to prevent rejection.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Voronoy U. Blocking the reticuloendothelial system in man in some forms of mercuric chloride intoxication and the transplantation of the cadaver kidney as a method of treatment for the anuria resulting from the intoxication. Siglo Med. 1937;97:296.
    1. Poggio E.D., Augustine J.J., Arrigain S., Brennan D.C., Schold J.D. Long-term kidney transplant graft survival-Making progress when most needed. Am. J. Transplant. 2021;21:2824–2832. doi: 10.1111/ajt.16463. - DOI - PubMed
    1. Lentine K.L., Smith J.M., Hart A., Miller J., Skeans M.A., Larkin L., Robinson A., Gauntt K., Israni A.K., Hirose R., et al. OPTN/SRTR 2020 Annual Data Report: Kidney. Am. J. Transplant. 2022;22((Suppl. S2)):21–136. doi: 10.1111/ajt.16982. - DOI - PubMed
    1. Lentine K.L., Gheorghian A., Axelrod D., Kalsekar A., L’Italien G., Schnitzler M.A. The implications of acute rejection for allograft survival in contemporary U.S. kidney transplantation. Transplantation. 2012;94:369–376. doi: 10.1097/TP.0b013e318259407f. - DOI - PubMed
    1. Wu J., Chen J., Wang Y., Zhang J., Zhu Z., Shou Z., Wang S., Zhang P., Huang H., He Q. Impact of acute rejection episodes on long-term renal allograft survival. Chin. Med. J. 2003;116:1741–1745. - PubMed

Grants and funding

This research received no external funding.