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Establishing Biomarkers in Transplant Medicine: A Critical Review of Current Approaches

Anglicheau, Dany MD, PhD; Naesens, Maarten MD, PhD; Essig, Marie MD, PhD; Gwinner, Wilfried MD, PhD; Marquet, Pierre MD, PhD

doi: 10.1097/TP.0000000000001321
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Although the management of kidney transplant recipients has greatly improved over recent decades, the assessment of individual risks remains highly imperfect. Individualized strategies are necessary to recognize and prevent immune complications early and to fine-tune immunosuppression, with the overall goal to improve patient and graft outcomes. This review discusses current biomarkers and their limitations, and recent advancements in the field of noninvasive biomarker discovery. A wealth of noninvasive monitoring tools has been suggested that use easily accessible biological fluids such as urine and blood, allowing frequent and sequential assessments of recipient's immune status. This includes functional cell-based assays and the evaluation of molecular expression on a wide spectrum of platforms. Nevertheless, the translation and validation of exploratory findings and their implementation into standard clinical practice remain challenging. This requires dedicated prospective interventional trials demonstrating that the use of these biomarkers avoids invasive procedures and improves patient or transplant outcomes.

This comprehensive review discusses current biomarkers and their limitations, and the recent advancements in the field of noninvasive biomarker discovery to make diagnoses and improve care for renal transplant recipients.

1 Necker-Enfants Malades Institute, French National Institute of Health and Medical Research, Paris, France.

2 Paris Descartes, Sorbonne Paris Cité University, Paris, France.

3 Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

4 KU Leuven-University of Leuven, Department of Microbiology and Immunology, Laboratory of Nephrology; University Hospitals Leuven, Department of Nephrology and Renal Transplantation, Leuven, Belgium.

5 CHU Limoges, Department of Nephrology, Dialysis and Transplantation, Limoges, France.

6 U850 INSERM, Univ. Limoges, CHU Limoges, Limoges, France.

7 Department of Nephrology, Hannover Medical School, Hannover, Germany.

Received 26 February 2016. Revision received 26 April 2016.

Accepted 27 April 2016.

This work is part of the BIOMARGIN European research network (Collaborative Project) supported by the European Commission under the Health Cooperation Work Programme of the 7th Framework Programme (grant 305499).

The authors declare no conflicts of interest.

D.A., M.N., M.E., W.G., and P.M. wrote the article.

Correspondence: Dany Anglicheau, MD, PhD, Service de Néphrologie et Transplantation Adulte, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France. (dany.anglicheau@aphp.fr).

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.