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Biomarkers of rejection in kidney transplantation

Singh, Neeraja; Samant, Hrishikeshb; Hawxby, Alanc; Samaniego, Millie D.d

Current Opinion in Organ Transplantation: February 2019 - Volume 24 - Issue 1 - p 103–110
doi: 10.1097/MOT.0000000000000606
RENAL TRANSPLANT: Edited by Yasir A. Qazi

Purpose of review To provide an update of the literature on the use of new biomarkers of rejection in kidney transplant recipients.

Recent findings The kidney allograft biopsy is currently considered the gold standard for the diagnosis of rejection. However, the kidney biopsy is invasive and could be indeterminate. A significant progress has been made in discovery of new biomarkers of rejection, and some of them have been introduced recently for potential use in clinical practice including measurement of serum donor-derived cell free DNA, allo-specific CD154 + T-cytotoxic memory cells, and gene-expression ‘signatures’. The literature supports that these biomarkers provide fair and reliable diagnostic accuracy and may be helpful in clinical decision-making when the kidney biopsy is contraindicated or is inconclusive.

Summary The new biomarkers provide a promising approach to detect acute rejections in a noninvasive way.

aDivision of Nephrology and Hypertension

bDivision of Gastroenterology and Hepatology, Department of Internal Medicine, LSU Health Shreveport School of Medicine, Shreveport, Louisiana

cDivision of Transplant Surgery, University of Oklahoma, Oklahoma City, Oklahoma

dDivision of Nephrology, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA

Correspondence to Neeraj Singh, MD, MBA, FASN, FASH, FAST, Medical Director, Kidney and Pancreas Transplant, John C McDonald Regional Transplant Center, Shreveport, Louisiana, USA; Associate Professor of Internal Medicine, Division of Nephrology, Louisiana State University Health Sciences Center Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA. Tel: +1 318 675 7402; fax: +1 318 675 5913; e-mail:

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