Advancing kidney transplantation in black patients: a genetics-based and personalized approach under NICE, KDIGO, and ERBP guidelines.

Induction therapy is a critical component of renal transplantation, aimed at reducing delayed graft function (DGF) and improving graft survival. This review assesses the impact of leading large national and international guidelines: National Institute for Health and Care Excellence (NICE), Kidney Disease: Improving Global Outcomes (KDIGO), and European Renal Best Practice (ERBP) propositions, focusing on their applicability to high-risk groups, specifically, on Black patients and those with donor-specific antibodies (DSAs). While NICE guidelines provide a standardized approach favoring basiliximab, concerns arise regarding their suitability for high-risk patients, who may benefit more from potent lymphocyte-depleting agents. KDIGO and ERBP guidelines advocate for personalized approaches, emphasizing genetic diversity and specific patient profiles to tailor immunosuppressive regimens effectively. This review advocates for a paradigm shift toward personalized induction therapy, integrating genetic insights to improve clinical outcomes and address health disparities. By tailoring induction therapies to the genetic and immunological profiles of transplant recipients, healthcare providers can enhance transplant success and ensure equitable healthcare for diverse populations. This approach underscores the importance of personalized medicine in achieving optimal outcomes in renal transplantation. This concern is of particular importance to Black individuals due to the specific genetic markers and health profiles relevant to this group, while recognizing the current gap in data regarding other ethnicities.