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Table 1 Risk stratification for selection of immunosuppression in kidney transplantation

From: Renal association clinical practice guideline in post-operative care in the kidney transplant recipient

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    Poor RRT compliance
Age <20
Transition from paediatric to adult
Education
Simple drug regime
alemtuzumab or belatacept