Table 1 Risk stratification for selection of immunosuppression in kidney transplantation
Risk Type | Low | Medium | High | Possible Strategy |
|---|---|---|---|---|
Immunological | 0-DR mismatch First graft Unsensitised Recipient >60 | 1-DR mismatch Afro-Caribbean recipient Historical DSAs NDSAs DGF Older donor [45] | 2-DR mismatch Previous early immunological graft loss DSAs ABO-incompatible Sensitised (high CRF/PRA) Preoperative anti-ATIIR Abs [117] | Increase total immunosuppressive load |
Metabolic | Low BMI Age <40 Normal pre-Tx GTT | Positive family history ADPKD | Impaired GT BMI >35 HCV positive Age >60 Previous CVD Race | Avoid/minimise steroids and tacrolimus |
Neoplastic | Age <40 | Pre-malignant lesion | Previous cancer Hereditary syndrome e.g. VHL | Consider low immunosuppression load or sirolimus |
Ischaemia-reperfusion injury | Living donor Deceased donor <40 | CIT >12 h Donor aged 50–60 | DCD CIT > 24 h Extended criteria donor | Reduce CNI exposure |
Non-adherence | Â | Â | Poor RRT compliance Age <20 Transition from paediatric to adult | Education Simple drug regime alemtuzumab or belatacept |