When and to whom should the IMBG be performed?

The test has been clinically tested in patients after more than one year of the transplant. The reason is that currently the major challenge for clinicians is to improve the graft survival after one year, reducing the risk of chronic allograft injury due to rejection, and avoiding at the same time immunosuppressive adverse effects like infections and malignancies. It is planned for the IMBG to be tested as well for its use in patients before transplantation.

It can be used to identify and monitor patients at risk of rejection (who might require an increase of immunosuppression or a change in the immunosuppressive regime prescribed), and in patients with low risk to profit from a gradual reduction of immunosuppression and avoidance of severe side effects.

Estimated monitoring frequency will depend on the patient profile. An IMBG should be done to all patients at baseline, once the immunological system has got stabilized after the induction therapy (6 months post RT). In the maintenance phase it is estimated that 1 IMBG per year should be performed in high immunological risk patients. Patients who present immunological events (ie. dnDSA) or adverse events which can lead to a change in immunosuppressive regimen can require an additional IMBG before undertaking a treatment change. The development of de novo (dn) DSA beyond one-year post-transplantation has been demonstrated to be strongly associated with graft loss through antibody-mediated rejections, and is often related with underimmunosuppression.