Published online Nov 6, 2015. doi: 10.5527/wjn.v4.i5.487
Peer-review started: May 31, 2015
First decision: July 10, 2015
Revised: July 24, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: November 6, 2015
Immunosuppressive drug level monitoring and serum creatinine are widely used for kidney transplantation (KT) monitoring. Monitoring of drug level is not the direct measurement of the immune response while the rising of creatinine is too late for detection of allograft injury. Kidney biopsy, the gold standard for KT monitoring, is invasive and may lead to complications. Many biomarkers have been discovered for direct monitoring of the immune system in KT and the benefit of some biomarkers has reached clinical level. In order to use biomarkers for KT monitoring, physicians have to understand the biology including kinetics of each marker. This can guide biomarker selection for specific condition. Herein, we summarize the recent findings of donor specific anti-human leukocyte antigen antibody, B lymphocyte stimulator, interferon-gamma induced protein of 10 kDa, and intracellular adenosine triphosphate monitoring, all of which have very strong evidence support for the clinical use in KT.
Core tip: There are many studies about roles and benefits of biomarkers in nephrology, including transplantation. Only some of them reach the clinical level with strong evidence support. Biomarkers can guide immunosuppressive adjustment, provide prognostic value, and guide early detect of allograft injury, particularly from allograft rejection. We summarized the potential biomarkers for kidney transplantation monitoring, including clinical implication, strength and weakness of each of them.