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  1. Infectious profile
    1. Hepatitis B and C serologies
    2. Epstein-Barr virus serologies (IgM and IgG)
    3. Cytomegalovirus (CMV) serologies (IgM and IgG)
    4. Varicella-zoster serologies (IgM and IgG)
    5. Rapid plasma reagin (RPR) test for syphilis
    6. HIV
    7. Purified protein derivative - TB skin test with anergy panel, when indicated
      Urinalysis, urine culture, and cytospin (when indicated)
  2. Other Tests:
    Recipients of kidney transplants undergo an extensive immunological evaluation that There are 4 components of the immunologic evaluation. 
  3. ABO blood group determination: Transplantation across incompatible blood groups may result in humoral-mediated hyperacute rejection.
    1. Human leukocyte antigen (HLA) typing:
      1. All transplant recipients are tissue typed to determine the HLA class I and class II loci.
      2. Six HLA antigens are determined. Q
      3. The kidney donors also are HLA typed, and the degree of incompatibility between the donor and recipient is defined by the number of antigens that are mismatched at each of the HLA loci. 
  4. Serum screening for antibody to HLA phenotypes
    1. Sensitization to histocompatibility antigens occurs when the recipient is sensitized because of receiving
    2. Multiple blood transfusions, a previous kidney transplant, or from pregnancy.
    3. Transplantation of a kidney into a recipient that is sensitized against donor class I HLA antigens puts the recipient at high risk of developing hyperacute antibody-mediated rejection.
    4. All transplant candidates are screened to determine the degree of humoral sensitization to HLA antigens. 
  5. Crossmatching: This immunologic test is conducted prior to transplantation. A negative crossmatch must be obtained prior to accepting a kidney for transplantation.  
  6. Histocompatability
    1. The important histocompatability systems are ABO and HLA system
    2. A and B substances are present on the endothelial cells and most individuals have the antibody to the RBC antigen they lack.
    3. The major histocompatability antigen are the glycoprotein on the cell membrane and are encoded by the major histocompatibility complex (MHC) gene present on the short arm of the Chr. 6.
    4. These agents are divided into class I and II. Class I antigen are HLA-A, HLA-B, and HLA-C, present on all nucleated cells and are detected by serotyping T Lymphocytes.
    5. Class I antigen are HLA-DR, HLA-DQ, and HLA-DP. Present on B lymphocytes activated T Cells, Monocytes, Macrophages, dendritic cells and some endothelial cells and HLA-DR is detected serotypinf B lymphocytes (Testing for HLA-DQ and DP is not routinely done).

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