Aldea Paul Luchian, Turbuleasa-Jurje Roxana Andreea, Bulata Bogdan, Delean Dan, Elec Florin Ioan, Ciumarnean Lorena, Bot Rachisan Andreea Liana
Renal Transplantation Unit, Urology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400023 Cluj-Napoca, Romania.
Department of Pediatric Nephrology, Cluj-Napoca Children's Hospital Gheorghieni, 400023 Cluj-Napoca, Romania.
Children (Basel). 2025 Jan 7;12(1):63. doi: 10.3390/children12010063.
Renal transplantation ensures particular advantages for patients with end-stage kidney disease. However, in some cases, early complications may result in allograft dysfunction, which can ultimately lead to the loss of the graft. Creatinine is a poor biomarker for kidney injury due principally to its inability to help diagnose early acute renal failure and complete inability to help differentiate among its various causes. Different urinary and serum proteins have been intensively investigated as possible biomarkers in this setting. We focused on emerging serum biomarkers such as kidney injury molecule 1 (KIM-1) on a cohort of grafted patients. The motivation of this study was to analyze a predictive biological marker in comparison with standard markers for the evaluation of renal function, with the aim of observing if there are statistically significant differences regarding the performance and promptness of its increase compared to the current monitoring methods in order to improve graft survival, quality of life, and overall patient prognosis.
We included 21 patients who had their first kidney transplantation (8 females, 13 males), with a follow-up period from transplantation of 3.14 years, without prior immunization, having complete HLA typing and a negative cross-match test before transplantation. We determined serum creatinine and KIM-1 in the whole cohort at the time of the enrollment in the study.
The mean creatinine value was 0.89 mg/dL ± 0.33. The mean value for KIM-1 was 13.56 +/- 21.52 in the Tx group vs. 5.91 +/- 3.26 in the control group with a -value of 0.06. We defined patients at low risk (LR) of graft loss (serum creatinine < 0.9 mg/dL) and those at high risk (HR) (serum creatinine > 0.91 mg/dL). The mean values for KIM-1 were 6.09 +/- 1.67 in the LR vs. 21.77 +/- 29.71 in the HR group, with a -value 0.01.
There is a strong difference for KIM-1 at 24 h postTx between the two groups, showing a high correlation between KIM-1 and the predisposition of the graft dysfunction. Further studies are needed in order to clarify the utility of these novel biomarkers in the prediction of graft survival in renal transplantation patients.
肾移植为终末期肾病患者带来了特殊优势。然而，在某些情况下，早期并发症可能导致移植肾功能障碍，最终可能导致移植肾丧失。肌酐作为肾损伤的生物标志物并不理想，主要原因在于其无法帮助诊断早期急性肾衰竭，且完全无法区分其各种病因。在此背景下，人们对不同的尿液和血清蛋白作为可能的生物标志物进行了深入研究。我们聚焦于新兴的血清生物标志物，如肾损伤分子1（KIM-1），对一组肾移植患者进行了研究。本研究的目的是分析一种预测性生物标志物，并与评估肾功能的标准标志物进行比较，以观察与当前监测方法相比，其升高的表现和及时性是否存在统计学上的显著差异，从而提高移植肾存活率、生活质量和患者总体预后。
我们纳入了21例首次接受肾移植的患者（8例女性，13例男性），移植后随访时间为3.14年，移植前未进行免疫接种，移植前进行了完整的HLA分型且交叉配型试验为阴性。在研究入组时，我们测定了整个队列的血清肌酐和KIM-1水平。
肌酐的平均值为0.89 mg/dL±0.33。移植组KIM-1的平均值为13.56 +/- 21.52，对照组为5.91 +/- 3.26，P值为0.06。我们将移植肾丢失低风险（LR）患者定义为血清肌酐<0.9 mg/dL的患者，高风险（HR）患者定义为血清肌酐>0.91 mg/dL的患者。LR组KIM-1的平均值为6.09 +/- 1.67，HR组为21.77 +/- 29.71，P值为0.01。
两组在移植后24小时的KIM-1水平存在显著差异，表明KIM-1与移植肾功能障碍的易感性之间存在高度相关性。需要进一步研究以阐明这些新型生物标志物在预测肾移植患者移植肾存活率方面的效用。
