Blood transcriptomics as non-invasive marker for kidney transplant rejection

Area of Science:

• Nephrology
• Transplant Immunology
• Biomarker Discovery

Background:

• Numerous peripheral blood molecular biomarkers for kidney transplant rejection have emerged.
• Assessing their clinical utility requires evaluation across diverse clinical scenarios.
• Current kidney function tests (e.g., estimated glomerular filtration rate, proteinuria) serve as non-invasive rejection biomarkers but cannot detect subclinical rejection.

Purpose of the Study:

• To review the performance of promising peripheral blood molecular biomarkers (e.g., blood transcriptomic markers, donor-derived cell-free DNA) in relation to graft function evaluation.
• To propose a standardized clinical model for non-invasive allograft rejection diagnosis as a benchmark.
• To facilitate the integration of novel molecular biomarkers with existing functional assessments.

Main Methods:

• Review of existing literature on peripheral blood molecular biomarkers for kidney transplant rejection.
• Comparative analysis of diagnostic performance between molecular markers and kidney functional parameters.
• Proposal of a standardized clinical model for non-invasive rejection diagnosis.

Main Results:

• Kidney functional parameters demonstrate clinical utility but miss subclinical rejection.
• Promising molecular biomarkers like transcriptomic markers and cfDNA show potential but require further validation.
• A standardized model is proposed to benchmark and integrate these novel biomarkers.

Conclusions:

• Peripheral blood molecular biomarkers offer potential for detecting subclinical kidney transplant rejection.
• Integration with a standardized non-invasive diagnostic model is essential for clinical utility.
• Further research is needed to validate and implement these biomarkers in routine practice.