Intraoperative biomarkers in renal transplantation

Abstract

This review summarizes the current evidence and potential clinical utility of established and novel renal biomarkers in predicting kidney transplant outcomes, including delayed graft function, acute rejection and graft loss. ABSTRACT:The emerging need for biomarkers in the management of renal transplantation is highlighted by the severity of related complications such as acute renal failure and ischaemia/reperfusion injury (IRI) and by the increasing efforts to identify novel markers of these events to predict and monitor delayed graft function (DGF) and long-term outcome. In clinical studies candidate markers such as kidney injury molecule-1, neutrophil gelatinaseassociated lipocalin and interleukin-18 have been demonstrated to be valid biomarkers with high predictive value for DFG in a post-transplant setting. However, studies investigating biomarkers for early diagnosis of IRI and assumable DGF as well as identification of potential graft recipients at increased risk at the time point of transplantation lack further confirmation and translation into clinical practice. This review summarizes the current literature on the value of IRI biomarkers in outcome prediction following renal transplantation as well their capacity as surrogate end points from an intraoperative perspective.

Prediction, prevention, and management of delayed graft function: where are we now?

“…Urinary interleukin‐18 (IL‐18) has also shown promising results . Evidence that other biomarkers of kidney damage, such as kidney injury molecule‐1 (KIM‐1) or liver‐type fatty‐acid‐binding protein (L‐FABP), is inconclusive. Further possible markers under assessment include the glycoprotein clusterin, the phosphoprotein osteopontin and the tumor necrosis factor α (TNF‐α) gene A20, markers of cell cycle arrest and inflammation, combinations of conventional and novel markers (e.g., creatinine, cystatin C, and malondialdehyde), T reg cell counts, and biomarkers obtained from hypothermic machine perfusion …”

Hepatic and renal expression of Oatp1 in obstructive uropathy. First detection of Oatp1 in urine, a potential biomarker

“…When the damage was severe (BUO24), the urinary excretion of interleukin-18 (IL-18) have been validated as biomarkers for early prediction of acute kidney injury (AKI) and delayed graft function in transplantation medicine. 30 However, it has been reported that urinary NGAL , KIM-1 and IL-18 were not able to identify aetiology of AKI in kidney transplant recipients (KTR). 31,32 Because ureteral obstruction is one of the etiological causes of AKI in KTR, 33 further studies deserve to be performed to evaluate the presence of urinary Oatp1 in KTR and its potential role as an ureteral obstruction biomarker in this context.…”

Intraoperative Near-Infrared Spectroscopy Monitoring of Renal Allograft Reperfusion in Kidney Transplant Recipients: A Feasibility and Proof-of-Concept Study

“…Up to now, conventional laboratory markers, such as serum creatinine, urine output in donors and cold ischemic time (CIT) are widely used to predict initial allograft function [ 9 ]. However, there are very limited reliable intraoperative methods to assess real-time allograft condition, resulting in late detection of slow allograft function and injury during the early post-transplant period [ 10 ]. Furthermore, transplant surgeons currently evaluate and predict initial allograft function in the critical early post-transplantation period through the assessment of color, texture, and capillary refill after reperfusion of the allograft, which is highly subjective and varies greatly based on the surgeons’ experience.…”