Journal
CLINICAL KIDNEY JOURNAL
Volume 10, Issue 1, Pages 97-105Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ckj/sfw062
Keywords
18FDG-PET/CT; acute rejection; kidney biopsy; kidney transplantation; magnetic resonance imaging; ultrasonography
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Funding
- University of Liege (Fonds Speciaux a la Recherche)
- University of Liege (Fonds Leon Fredericq)
- ULg CHU (Fonds d'Investissement de Recherche Scientifique)
- Royal Academy of Medicine of Belgium (Prix O. Dupont)
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Kidney transplantation (KTx) represents the best available treatment for patients with end-stage renal disease. Still, full benefits of KTx are undermined by acute rejection (AR). The diagnosis of AR ultimately relies on transplant needle biopsy. However, such an invasive procedure is associated with a significant risk of complications and is limited by sampling error and interobserver variability. In the present review, we summarize the current literature about non-invasive approaches for the diagnosis of AR in kidney transplant recipients (KTRs), including in vivo imaging, gene expression profiling and omics analyses of blood and urine samples. Most imaging techniques, like contrast-enhanced ultrasound and magnetic resonance, exploit the fact that blood flow is significantly lowered in case of AR-induced inflammation. In addition, AR-associated recruitment of activated leukocytes may be detectable by F-18-fluoro-deoxy-glucose positron emission tomography. In parallel, urine biomarkers, including CXCL9/CXCL10 or a three-gene signature of CD3 epsilon, IP-10 and 18S RNA levels, have been identified. None of these approaches has been adopted yet in the clinical follow-up of KTRs, but standardization of procedures may help assess reproducibility and compare diagnostic yields in large prospective multicentric trials.
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