Kidney transplantation is the treatment of choice for patients with end stage renal failure. It has by large demonstrated to improve patients QoL and decrease treatment costs.
However, these patients have a persistent risk of graft rejection due to immune-mediated kidney injury. The immune system of the recipient can recognize as strange the donor-specific- antigens expressed by the graft, mainly from the human leukocyte antigen (HLA) complex (alloantigens). An alloimmune response is developed in the recipient against the donor graft alloantigens that is responsible for graft tissue damages, and can lead to the failure of the transplanted organ.
To limit the risk of rejection, transplanted kidney patients require long term treatment with different immunosuppressive drugs (IS) and doses. Treatment with IS has driven overall improvements in graft survival, mainly during the first-year after kidney transplantation, but long-term survival has improved only slightly over decades. Recent data from registers show that graft failure at 10 years from transplant occurs in about 57 % patients in USA (Annual Report 2018 USRDS) and in about 50% in Spain, (Registre de malalts renals de Catalunya) (deceased donors, unadjusted).1,2,3,4
On the other hand, immunosuppression can lead to different side effects that cause a substantial clinical burden for the patients, and negatively affect patient and allograft survival, metabolic toxicities (hypertension, hyperlipidemia, diabetes, bone loss), and serious adverse events like malignancies and opportunistic infections.
Currently, prescribed IS regimens are based on standard clinical guidelines, drug blood levels and empirical use. There is a lack of biomarkers to help health professionals to stablish a personalized therapeutic immunosuppression plan for each patient according to the individual response profile to IS.
IMBG has been developed to test the patient´s profile of sensitivity/resistance to each immunosuppressant. It is a tool that, taken together with other important variables, can help physicians to make more precise therapeutic decisions, and contribute to decrease the risk of rejection due to under-immunosuppression, and decrease the burden of IS adverse events due to over-immunosuppression.