Seeto R K, Fleming J N, Dholakia S, Dale B L
University of Sydney, Sydney, NSW, Australia.
Medical University of South Carolina College of Pharmacy, Charleston, SC, USA.
Biophys Rev. 2020 Aug;12(4):917-924. doi: 10.1007/s12551-020-00713-5. Epub 2020 Jul 18.
Renal transplant is a lifesaving and cost-effective intervention for patients with End Stage Renal Failure. Yet it is often regarded as replacement therapy rather than a cure given the overall failure rate over time. With a shortage of organs, this global issue has been further compounded by increased incidences of obesity, hypertension and diabetes, such that the disease burden and need for transplantation continues to increase. Considering the lifetime of immunosupression in transplant patients, there will also be significant associated co-morbidities By leveraging the advances in innovation in Next Generation Sequencing, the field of transplant can now monitor patients with an optimized surveillance schedule, and change the care paradigm in the post-transplant landscape. Notably, low grade inflammation is an independent risk for mortality across different disease states. In transplantation, sub-clinical inflammation enhances acute and chronic rejection, as well as accelerates pathologies that leads to graft loss. Cell free DNA has been shown to be increased in inflammatory processes as we all as provide an independent predictor of all-cause mortality. This review considers the utility of AlloSure, a donor derived cell free DNA molecular surveillance tool, which has shown new clinical insights on how best to manage renal transplant patients, and how to improve patient outcomes.
肾移植对于终末期肾衰竭患者而言是一种挽救生命且具有成本效益的干预措施。然而，鉴于随着时间推移的总体失败率，它常常被视为替代疗法而非治愈方法。由于器官短缺，肥胖、高血压和糖尿病发病率的上升使这个全球问题进一步恶化，以至于疾病负担和移植需求持续增加。考虑到移植患者需要终身免疫抑制，还会出现显著的相关合并症。通过利用下一代测序技术创新的进展，移植领域现在可以通过优化的监测方案对患者进行监测，并改变移植后阶段的护理模式。值得注意的是，低度炎症是不同疾病状态下死亡的独立风险因素。在移植中，亚临床炎症会增强急性和慢性排斥反应，并加速导致移植物丢失的病理过程。游离DNA已被证明在炎症过程中会增加，并且是全因死亡率的独立预测指标。本综述探讨了AlloSure（一种供体来源的游离DNA分子监测工具）的效用，它在如何最佳管理肾移植患者以及如何改善患者预后方面展现了新的临床见解。
