Using biomarkers of tolerance and rejection to identify high- and low-risk patients following kidney transplantation.

Despite great improvements in renal allograft survival over the last 3 decades, long-term graft loss, particularly through antibody-mediated rejection, remains the bane of kidney transplantation. Interindividual patient variation means that a given immunosuppressive regimen may be inadequate in certain patients and excessive in others. Currently, there is no way of personalizing such treatments. We believe that this may be made possible by evaluating the degree of immunologic "risk" in a transplant recipient. Such immunological risk assessment would enable those patients at low risk to be at least partially or totally weaned from immunosuppression, whereas those at high risk could benefit from an increase or adjustment in their immunosuppression. Here, we outline our own group's efforts in the identification of peripheral blood biomarkers of high- and low-immunologic risk in relationship to the current literature on the subject.