Immunologic monitoring of the renal transplant recipient
Immune monitoring, at its best, is the result of a successful marriage of basic and applied research in the area of tansplantation biology. Careful clinical investigations, based on sound basic research with various transplant models, have led to the unraveling of complex immunologic mechanisms operative in the rejection of allografts. Immunologically, it is no surprise that histoincompatible grafts fail in some instances, and a single immune assay that can predict graft compromise resulting from multiple host assault mechanisms does not exist. It is heartening that we can indeed measure individual reactivity, investigate graft destructive and protective mechanisms, and predict or confirm rejection episodes including their reversibility. The science of monitoring has crossed the initial narrow aim of being a diagnostic tool for rejection. Individualization of immune therapy and specific modulation of immune responses, the cherished goals of the transplant clinician, can be expected to be accomplished in the near future. We are optimistic.