Baguant Rachna, Bertrand Dominique, François Arnaud, Grangé Steven, Guerrot Dominique, Laurent Charlotte, Lemoine Mathilde, Candon Sophie, de Nattes Tristan
CHU Rouen, département de néphrologie, Rouen, France
CHU Rouen, département de pathologie, Rouen, France
Nephrol Ther. 2025 Jun 27;21(3):184-194. doi: 10.1684/ndt.2025.125.
Despite advances in the physiopathological understanding of kidney transplantation immunology, kidney transplant rejection remains the leading cause of allograft loss. The current gold standard for diagnosing rejection is histological assessment of kidney transplant biopsies. Biopsy-based transcriptomics have been the subject of numerous studies, enabling the analysis of hundreds of transcripts expressed in biopsy samples. These tools allow for the identification of new pathophysiological pathways, providing a better understanding of rejection and potentially revealing therapeutic targets. Biopsy-based transcriptomics may also improve the diagnosis of rejection, in particular antibody-mediated rejection. However, the use of these tools in routine practice is limited due to restricted availability, the challenge of interpreting data from hundreds of transcripts without clear guidelines, and their cost. In addition, due to the limited accessibility of molecular tools, their exact impact on patient management has not yet been determined. This update provides an overview of biopsy-based transcriptomics in 2025, focusing on the limitations of current diagnostic methods for rejection, the molecular biology tools available, and their use in clinical practice.
尽管在肾移植免疫学的生理病理学理解方面取得了进展，但肾移植排斥反应仍然是同种异体移植丢失的主要原因。目前诊断排斥反应的金标准是对肾移植活检进行组织学评估。基于活检的转录组学已成为众多研究的主题，能够分析活检样本中表达的数百种转录本。这些工具有助于识别新的病理生理途径，更好地理解排斥反应，并有可能揭示治疗靶点。基于活检的转录组学还可能改善排斥反应的诊断，特别是抗体介导的排斥反应。然而，由于可用性受限、在没有明确指南的情况下解读数百种转录本数据的挑战以及成本问题，这些工具在常规实践中的应用受到限制。此外，由于分子工具的可及性有限，它们对患者管理的确切影响尚未确定。本更新概述了2025年基于活检的转录组学，重点关注当前排斥反应诊断方法的局限性、可用的分子生物学工具及其在临床实践中的应用。
