Personalization of Immunosuppressive Treatment for Organ Transplant Recipients

Surveillance Testing Utilizing AlloSure to Assess Rejection Following Transplantation and Personalization of Immunosuppressive Therapy

Long-term graft failure rates continue to be unacceptably high despite the development of immunosuppressive drugs, underscoring the unmet need for robust prognostic biomarkers of allograft injury and failure. While rates of acute rejection (AR) continue to decrease, it remains the strongest predictor of long-term allograft survival, and so having a better understanding of factors predicting AR may contribute to more individualized patient care. Selecting optimum immunosuppressive dosage is another factor in personalizing kidney care. This project will study two areas of individualized kidney care: 1) assessing rejection by surveillance testing utilizing AlloSure, 2) developing an algorithm to select optimum immunosuppressive medication dosage.

Inclusion Criteria:

• Adult 18-80 year old
• Kidney transplant recipients (de novo or re-transplant, from living or deceased donor)
• BMI over 30
• Recipients with pre formed human leukocyte antigens (HLA) antibodies
• Recipients with donor specific antibodies
• Recipients who have undergone blood type incompatible transplantation (ABO incompatible)
• Recipients who have had prior kidney transplants.

Exclusion Criteria:

• Multi-Visceral transplant (simultaneous kidney pancreas, liver kidney, heart kidney)
• Contraindication to renal biopsy
• Refusing biopsy
• Kidney transplant recipient that is a monozygotic twin to the donor
• When more than two genomes may be present in the recipient plasma (more than recipient + donor): pregnancy, multiple-organ transplants from different donors (kidney after heart, kidney after liver transplant etc.), recipients of allogeneic blood or bone marrow transplant who have received cells with a genome different from the recipient (e.g. non-monozygotic twin)