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REVIEW article

Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1490472

Current and emerging tools for simultaneous assessment of infection and rejection risk in transplantation

Provisionally accepted
Dhakshayini Tharmaraj Dhakshayini Tharmaraj 1,2*William R. Mulley William R. Mulley 1,2Claire Dendle Claire Dendle 2,3
  • 1 Department of Nephrology, Monash Health, Clayton, Australia
  • 2 Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
  • 3 Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia

The final, formatted version of the article will be published soon.

    Infection and rejection are major complications that impact transplant longevity and recipient survival. Balancing their risks is a significant challenge for clinicians. Current strategies aimed at interrogating the degree of immune deficiency or activation and their attendant risks of infection and rejection are imprecise. These include immune (cell counts, function and subsets, immunoglobulin levels) and non-immune (drug levels, viral loads) markers. The shared risk factors between infection and rejection and the bidirectional and intricate relationship between both entities further complicate transplant recipient care and decisionmaking. Understanding the dynamic changes in the underlying net state of immunity and the overall risk of both complications in parallel is key to optimizing outcomes. The allograft biopsy is the current gold standard for the diagnosis of rejection but is associated with inherent risks that warrant careful consideration. Several biomarkers, in particular, donor derived cell-free-DNA and urinary chemokines (CXCL9 and CXCL10), show significant promise in improving subclinical and clinical rejection risk prediction, which may reduce the need for allograft biopsies in some situations. Integrating conventional and emerging risk assessment tools can help stratify the individual's short-and longer-term infection and rejection risks in parallel. Individuals identified as having a low risk of rejection may tolerate immunosuppression (IS) wean to reduce medication-related toxicity. Serial monitoring following IS reduction or escalation with minimally invasive tools can help mitigate infection and rejection risks and allow for timely diagnosis and treatment of these complications, ultimately improving allograft and patient outcomes.

    Keywords: Infection, rejection, transplant, Immunity, risk, biomarkers

    Received: 03 Sep 2024; Accepted: 14 Oct 2024.

    Copyright: © 2024 Tharmaraj, Mulley and Dendle. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Dhakshayini Tharmaraj, Department of Nephrology, Monash Health, Clayton, Australia

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.