Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia.
Department of Nephrology, Prince of Wales Hospital, High Street, Randwick, Sydney, NSW, 2031, Australia.
Mol Diagn Ther. 2019 Jun;23(3):333-351. doi: 10.1007/s40291-019-00396-z.
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.
移植肾损伤的早期检测对于维持长期良好的移植物功能至关重要。移植物损伤可能由多种因素引起，包括缺血再灌注损伤、细胞或抗体介导的排斥反应、进行性间质纤维化和肾小管萎缩、感染以及免疫抑制剂本身的毒性。目前评估肾移植肾功能障碍的金标准是肾活检。然而，当血清肌酐发生变化时，活检通常较晚，并且在组织学变化不确定时，对于早期损伤的诊断作用有限。因此，需要及时、客观和非侵入性的诊断技术，具有良好的早期预测价值，以确定移植物损伤并提供免疫抑制滴定的精确性。我们回顾了潜在的新型血浆和尿液生物标志物，这些标志物为早期检测提供了敏感的新策略，并为移植物损伤的机制提供了主要见解。这是一个快速发展的领域，但可能需要组合使用多种生物标志物，以提供足够的敏感性和特异性来检测移植物损伤。
