Diagnostic methods before a desensitization protocol:

1. Detailed clinical history
2. Physical examination
3. Allergy testing (skin prick test, intradermal test, or patch test when appropriate)
4. Serum specific IgE testing (for selected allergens/drugs)

5. Basophil activation test (BAT) (in selected cases)
6. Graded drug challenge (drug provocation test) – gold standard when allergy is uncertain and clinically appropriate
7. Ultrasound or other imaging – not routinely used for diagnosing drug allergy; may be performed only to evaluate the underlying disease or related complications.

Careful testing is required to determine the level of immunological risk and guide desensitisation treatment.

HLA Crossmatch Test: The HLA crossmatch test checks whether antibodies in the recipient’s blood react against donor cells.

Important points about this test include:

· A negative crossmatch suggests compatibility between donor and recipient.

· A positive crossmatch indicates a higher rejection risk.

· Repeat crossmatch testing is often performed before transplant surgery.

· This test helps doctors decide whether desensitisation therapy is required.

Donor Specific Antibodies Testing: Another important test identifies donor-specific antibodies (DSA). These antibodies target proteins on donor cells called human leukocyte antigens (HLA).

DSA testing helps doctors:

· Identify antibodies directed against the donor.

· Measure antibody strength levels.

· Monitor response to desensitisation therapy.

· Monitoring DSA levels over time is critical in transplant preparation.

Additional Pre-Transplant Evaluation: Patients undergoing desensitisation must also complete a full transplant evaluation.

This evaluation may include:

· Screening for infections such as hepatitis, HIV, and tuberculosis.

· Heart fitness testing, including ECG and echocardiography.

· Blood tests to assess kidney function and electrolyte balance.

· Dialysis planning is needed before transplant.

· Nutritional and metabolic assessment.

· These steps ensure the patient is medically fit for transplant surgery.

Desensitisation Protocols for Kidney Transplant