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Advances in Detection of Kidney Transplant Injury

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Abstract

Early detection of graft injury after kidney transplantation is key to maintaining long-term good graft function. Graft injury could be due to a multitude of factors including ischaemia reperfusion injury, cell or antibody-mediated rejection, progressive interstitial fibrosis and tubular atrophy, infections and toxicity from the immunosuppressive drugs themselves. The current gold standard for assessing renal graft dysfunction is renal biopsy. However, biopsy is usually late when triggered by a change in serum creatinine and of limited utility in diagnosis of early injury when histological changes are equivocal. Therefore, there is a need for timely, objective and non-invasive diagnostic techniques with good early predictive value to determine graft injury and provide precision in titrating immunosuppression. We review potential novel plasma and urine biomarkers that offer sensitive new strategies for early detection and provide major insights into mechanisms of graft injury. This is a rapidly expanding field, but it is likely that a combination of biomarkers will be required to provide adequate sensitivity and specificity for detecting graft injury.

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Authors and Affiliations

  1. Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia

    Sanjeeva Herath, Jonathan Erlich, Amy Y. M. Au & Zoltán H. Endre

  2. Department of Nephrology, Prince of Wales Hospital, High Street, Randwick, Sydney, NSW, 2031, Australia

    Amy Y. M. Au & Zoltán H. Endre

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  1. Sanjeeva Herath
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Correspondence to Zoltán H. Endre.

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ZHE has received travel support from Ortho Diagnostics, Roche Pharmaceuticals and the Novartis Australian Renal Transplant Advisory Board. SH, JE and AYMA declare that they have no conflicts of interest.

Funding

ZHE has received research funding from the Australian National Health and Medical Research Council and the New Zealand Health Research Council. SH has received funding from the Prince of Wales clinical school scholarship, Australia.

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Herath, S., Erlich, J., Au, A.Y.M. et al. Advances in Detection of Kidney Transplant Injury. Mol Diagn Ther 23, 333–351 (2019). https://doi.org/10.1007/s40291-019-00396-z

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