Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2017; 7(3): 161-178
Published online Jun 24, 2017. doi: 10.5500/wjt.v7.i3.161
Biomarkers in renal transplantation: An updated review
Maurizio Salvadori, Aris Tsalouchos
Maurizio Salvadori, Renal Unit, Department of Transplantation, Careggi University Hospital, 50139 Florence, Italy
Aris Tsalouchos, Division of Nephrology, Careggi University Hospital, 50134 Florence, Italy
Author contributions: Salvadori M and Tsalouchos A equally contributed to the manuscript.
Conflict-of-interest statement: Maurizio Salvadori and Aris Tsalouchos do not have any conflict of interest in relation to the manuscript, as in the attached form.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maurizio Salvadori, MD, Renal Unit, Department of Transplantation, Careggi University Hospital, viale Pieraccini 18, 50139 Florence, Italy. maurizio.salvadori1@gmail.com
Telephone: +39-55-597151 Fax: +39-55-597151
Received: February 7, 2017
Peer-review started: February 12, 2017
First decision: March 29, 2017
Revised: April 7, 2017
Accepted: April 18, 2017
Article in press: April 19, 2017
Published online: June 24, 2017
Abstract

Genomics, proteomics and molecular biology lead to tremendous advances in all fields of medical sciences. Among these the finding of biomarkers as non invasive indicators of biologic processes represents a useful tool in the field of transplantation. In addition to define the principal characteristics of the biomarkers, this review will examine the biomarker usefulness in the different clinical phases following renal transplantation. Biomarkers of ischemia-reperfusion injury and of delayed graft function are extremely important for an early diagnosis of these complications and for optimizing the treatment. Biomarkers predicting or diagnosing acute rejection either cell-mediated or antibody-mediated allow a risk stratification of the recipient, a prompt diagnosis in an early phase when the histology is still unremarkable. The kidney solid organ response test detects renal transplant recipients at high risk for acute rejection with a very high sensitivity and is also able to make diagnosis of subclinical acute rejection. Other biomarkers are able to detect chronic allograft dysfunction in an early phase and to differentiate the true chronic rejection from other forms of chronic allograft nephropathies no immune related. Finally biomarkers recently discovered identify patients tolerant or almost tolerant. This fact allows to safely reduce or withdrawn the immunosuppressive therapy.

Keywords: Renal transplantation, Biomarkers, Genomic, Proteomics, Transplant outcome, Molecular signatures

Core tip: The uses of biomarkers as a non invasive tool instead of renal biopsy in diagnosing transplant renal complications are entering the clinical practice. Progress in genomics, proteomics and all the “omics” fields has allowed the finding of robust, predictive and useful biomarkers. They are modifying our window on transplantation and are allowing us to predict the renal injury earlier because the pathologic process is evident at molecular level before its histological or clinical manifestations. The future is exciting because new international researches and trials are ongoing in this field.