According to the NIH, approximately 10% to 15% of kidney recipients experience transplant rejection within a year. In order to determine diagnosis of acute rejection in kidney transplants, renal biopsies are standard.

Weill Cornell Medical College’s Manikkam Suthanthiran, M.D., and his colleagues describe in the New England Journal of Medicine this week a noninvasive approach to monitoring kidney transplant rejection status, based on a three-gene signature.

Dr. Suthanthiran et al. measured mRNA levels in urinary cells from 4,300 specimens collected prospectively from 485 kidney transplant recipients from day three through month 12. They then analyzed the resulting data, finding a correlation between mRNA readouts and transplant-rejection status.

The researchers report that the mRNA-based signature “distinguished acute cellular rejection from acute antibody-mediated rejection and borderline rejection” as well as “patients who received anti-interleukin-2 receptor antibodies from those who received T-cell-depleting antibodies.” Overall, Dr. Suthanthiran and his colleagues found that a combination of CD3ε mRNA, IP-10 mRNA, and 18S rRNA levels in urinary cells was diagnostic and prognostic of acute cellular rejection in kidney transplants.

“The development of a noninvasive test to monitor kidney transplant rejection status is an important advance that will allow doctors to intervene early to prevent rejection and the kidney injury it causes, which should improve long-term outcomes for transplant recipients,” National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony S. Fauci, M.D., said in a statement.

Added NIAID’s Daniel Rotrosen, M.D., director of allergy, immunology, and transplantation: “By tracking a transplant recipient’s rejection status over time, doctors may be able to modulate doses of immunosuppressive drugs to extend the survival of the transplanted kidney.”

“Urinary cell mRNA profile and acute cellular rejection in kidney allografts” appeared in the New England Journal of Medicine July 4.

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