IMMUNITY AFTER KIDNEY TRANSPLANTATION: MODERN CHALLENGES AND PROSPECTS

Parabina Elena Valeryevna, Fatenkov Oleg Veniaminovich, Mironov Alexey Alexandrovich, Myakotnykh Maxim Nikolaevich, Svetlova Galina Nikolaevna

Kidney transplantation remains the most effective method of treating end-stage chronic kidney disease (CKD), but the success of the procedure depends on the control of the recipient's immune response to the donor organ. Key aspects of transplant immunity are considered, including the mechanisms of hyperacute, acute and chronic rejection, as well as prospects for the induction of immunological tolerance. Particular attention is paid to immune dysregulation in patients with CKD, such as a combination of immunodeficiency, chronic inflammation, and imbalance of regulatory (Treg) and proinflammatory (Th17) T cells, which increases the risk of postoperative complications. Innovative approaches in diagnostics and therapy are discussed: the use of biomarkers (suPAR, exosomes), flow cytometry for monitoring the immune status, and genetic screening for personalizing doses of immunosuppressants. Cell therapy (Treg, mesenchymal stromal cells), the creation of bioengineered organs, and targeted drugs that block intracellular signaling pathways of immune activation are recognized as promising areas. The need for a transition to personalized medicine that combines precision diagnostics, minimizing the toxicity of therapy, and the development of long-term tolerance methods is emphasized. These strategies can significantly improve graft survival and the quality of life of patients, opening new horizons in transplantology.

Keywords:kidney transplantation, transplant immunity, immunosuppressive therapy, transplant rejection, immunological tolerance, chronic kidney disease, Treg/Th17 imbalance, personalized medicine, cell therapy, bioengineered organs, targeted immunosuppression, flow cytometry, genetic screening, uremic immune dysfunction