Abstract

The wide variety of immunosuppressive treatments and protocols makes it possible to tailor the initial treatment plan to each patient’s immunological risk status. There is a lack of agreement regarding which parameters should be taken into consideration and their relative importance in the pre-transplant risk assessment. It is common knowledge that younger patients are more likely to experience acute rejection, which is made worse by the higher rates of nonadherence among adolescents. Black recipient ethnicity continues to be a well-established risk factor even under modern immunosuppression regimens, despite the fact that donor age and recipient gender do not appear to have a significant impact on the risk of rejection per se. presently; there is little evidence of a risk difference between recipients of organs from deceased donors and those from living donors. In recent years, immunological risk assessment has advanced significantly. Flow cytometry has long been used to supplement cross-match testing with cytotoxic analysis. However, the development of solid-phase single-bead antigen testing of solubilized human leukocyte antigens (HLA) to detect donor-specific antibodies (DSA) enables a much more nuanced classification of immunological risk status, including the various classes and intensities of HLA antibodies Class I and/or II, including HLA-DSA. Other assessments, such as the measurement of non-HLA antibodies against AT1 receptors or the T-cell ELISPOT assay of alloantigen-specific donor, are becoming increasingly common in immunological risk evaluation. Immunological risk may be reduced by targeted desensitization protocols, particularly in DSA-positive patients with negative cytotoxicity and flow cross-match. Undisputedly, HLA mismatch remains a significant rejection risk factor. The early treatment plan can be altered in situations where delayed graft function also increases the likelihood of subsequent acute rejection. Overall, pre-transplant immunology testing is being used to plan the immunosuppressive regimen, though some traditional risk factors are still important.