Anfaiha-Sanchez Miriam, Rodrigo Calabia Emilio, Ortiz Alberto, Martin-Lorenzo Marta, Alvarez-Llamas Gloria
Immunology Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
Nephrology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain.
Clin Kidney J. 2022 Oct 15;16(3):447-455. doi: 10.1093/ckj/sfac227. eCollection 2023 Mar.
Kidney transplantation is the treatment of choice for patients with kidney failure. Priority on the waiting list and optimal donor-recipient matching are guided by mathematical scores, clinical variables and macroscopic observation of the donated organ. Despite the increasing rates of successful kidney transplantation, maximizing the number of available organs while ensuring the optimum long-term performance of the transplanted kidney remains both key and challenging, and no unequivocal markers are available for clinical decision making. Moreover, the majority of studies performed thus far has focused on the risk of primary non-function and delayed graft function and subsequent survival and have mainly analysed recipients' samples. Given the increasing use of donors with expanded criteria and/or cardiac death, predicting whether grafts will provide sufficient kidney function is increasingly more challenging. Here we compile the available tools for pre-transplant kidney evaluation and summarize the latest molecular data from donors that may predict short-term (immediate or delayed graft function), medium-term (6 months) and long-term (≥12 months) kidney function. The use of liquid biopsy (urine, serum, plasma) to overcome the limitations of the pre-transplant histological evaluation is proposed. Novel molecules and approaches such as the use of urinary extracellular vesicles are also reviewed and discussed, along with directions for future research.
肾移植是肾衰竭患者的首选治疗方法。等待名单上的优先级和最佳供体-受体匹配由数学评分、临床变量以及对捐赠器官的宏观观察来指导。尽管肾移植成功率不断提高，但在确保移植肾长期最佳性能的同时，最大限度地增加可用器官数量仍然是关键且具有挑战性的，并且目前尚无明确的标志物用于临床决策。此外，迄今为止进行的大多数研究都集中在原发性无功能和移植肾功能延迟以及随后存活的风险上，并且主要分析受者样本。鉴于扩大标准供体和/或心脏死亡供体的使用越来越多，预测移植物是否能提供足够的肾功能变得越来越具有挑战性。在这里，我们汇总了移植前肾脏评估的可用工具，并总结了来自供体的最新分子数据，这些数据可能预测短期（即刻或延迟移植肾功能）、中期（6个月）和长期（≥12个月）的肾功能。我们提出使用液体活检（尿液、血清、血浆）来克服移植前组织学评估的局限性。还对新型分子和方法（如使用尿细胞外囊泡）进行了综述和讨论，并给出了未来研究方向。
