Biomarkers to assess donor-reactive T-cell responses in kidney transplant patients.

Different to antibody-mediated rejection (ABMR), T-cell mediated rejection (TCMR) still unpredictably occurs after kidney transplantation in a great part because of a poor immunologic evaluation of the cellular allogeneic immune response. However, in the last years, important efforts have focused on the development of novel and more sensitive assays to monitor T-cell alloimmune responses at different biological levels that may improve the understanding of the functional status of the cellular immune compartment in patients undergoing organ transplantation. In this direction, immune assays evaluating T-cell proliferation, intracellular ATP release, multiparameter flow cytometry, profiling T-cell receptor repertoires and measurements of frequencies of cytokine-producing T-cells using an IFN-γ enzyme-linked immunospot assay (IFN-γ ELISPOT) have been reported showing interesting associations between the cellular alloimmune response and kidney transplant outcomes. In summary, an important progress has been made in the assessment of alloreactive T-cell responses in the context of organ transplantation using novel immune assays at different biological levels. However, there is an urgent need for prospective, randomized clinical studies to validate these encouraging preliminary data to ultimately introduce them in current clinical practice for refining current immune-risk stratification in kidney transplantation.