Immune Gene Polymorphisms Associate with Outcome in Kidney Transplantation

A short cold ischemic time, an optimal HLA match and other pre-transplant factors are in a key role in the success of kidney transplantation. Over the past decades, the acute rejection rate of kidney transplants has fallen dramatically and the 1-year graft survival rate has increased to 90% in transplantations with deceased donors and 95% with living related donors. This increase in graft survival is largely due to advances in immunosuppressant medication (Yates & Nicholson, 2006). But, due to undesired side effects usually associated with immunosuppressive regimens, reduced immunosuppression is warranted whenever possible. Acute rejection has been the most common end point of genetic association studies. This is natural as acute rejection predicts decreased long-term allograft survival. Despite progress in immunosuppression, the long-term graft survival has not increased in patients suffering acute rejection episodes (Meier-Kriesche et al., 2004). In many genetic studies, chronic allograft nephropathy and subsequent graft loss have been the endpoints with which genetic variation has been compared.