Abstract
Kidney transplantation is the best treatment modality for end-stage kidney disease, leading to improvement in a patient’s quality and quantity of life. With significant improvements in short-term outcomes, prolonging long-term allograft and patient survival remain ongoing challenges. The ability to monitor allograft function, immune tolerance and predict rejection accurately would enable personalization and better prognostication during post-transplant care. Though kidney biopsy remains the backbone of transplant diagnostics, emerging biomarkers can help detecting kidney allograft injury early enough to prevent permanent damage and detect injury before it is clinically apparent. In this review, we summarize the recent biomarkers that have shown promise in the prediction of acute rejection with a focus on antibody-mediated rejection in kidney transplantation.
Highlights
In the current era of kidney transplantation, one-year patient and allograft survival exceed 95% [1]
The presence of pre-existing or de novo donor-specific antibodies (DSA), histologic evidence of glomerular injury and microcirculatory inflammation that have been implicated in development of transplant glomerulopathy and/or late kidney allograft failure are antibody-mediated processes [6,7,8,9,10]
Multiple single-center studies in adults and pediatric kidney transplant recipients have shown the association of C3d and C1q binding of DSA to be associated with the risk of antibody-mediated rejection (ABMR) and allograft survival [34,35,36,37]
Summary
In the current era of kidney transplantation, one-year patient and allograft survival exceed 95% [1]. Though a comparison of older cohorts of kidney transplant recipients to recent cohorts shows improving long-term outcomes, five-year patient and allograft survival continue to lag behind [2]. Antibody-mediated rejection (ABMR) continues to be a crucial factor in poor long-term graft survival and could present many years after transplantation [3,4,5]. Kidney biopsy is subject to sampling error and interobserver variability between pathologists and different transplant centers [15] Markers such as creatinine and DSAs may not be elevated until the disease process has reached an advanced stage and miss the window of treating an early subclinical rejection, which can impact long-term graft outcome [16].
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