ArticleClinical transplantation2026
ISOT Position Statement on Immunological Evaluation in Kidney Transplantation.
Article in Clinical transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundImmunological evaluation plays a central role in kidney transplantation, guiding donor selection, risk assessment, and graft outcomes. Although international guidelines are comprehensive, applying them in a real-world low resource setting can be challenging where laboratory capacity varies and access to advanced testing is limited. There is therefore a need for implementable guidelines that reflect local realities while maintaining clinical rigor.
methodsThe Indian Society of Organ Transplantation (ISOT) brought together a multidisciplinary panel of transplant nephrologists, surgeons, clinical immunologists, and histocompatibility laboratory scientists from centers across India. A focused review of international guidelines, systematic reviews, and key studies was undertaken. Draft recommendations were developed and shared ahead of a structured consensus meeting. These were discussed, refined, and finalized through iterative expert deliberation. Recommendations were classified as "Recommended" or "Suggested" based on consensus, and their evidentiary basis was clearly defined.
resultsA total of 48 consensus recommendations were developed across 13 thematic areas covering key aspects of immunological evaluation. These included immunological risk assessment, antibody screening and crossmatch testing including virtual crossmatch, sensitization assessment, serum sampling and waitlist monitoring, HLA typing, post-transplant monitoring, laboratory governance and immunological assessment in ABO-incompatible transplantation. Of these, 23 were "Recommended" and 25 "Suggested." Additional guidance focused on resource-adapted and cost-conscious approaches suited to the Indian context.
conclusionsThese recommendations offer a practical and standardized framework for immunological evaluation in kidney transplantation within low- and middle-income settings. Their adoption has the potential to improve patient safety and optimize graft outcomes.
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