title: Molecular monitoring of alloimmune-mediated injury in kidney transplant patients.
abstract: OBJECTIVE
  Rapid progress in molecular technology has allowed development of numerous molecular tools to help the clinician to evaluate graft status in kidney transplant patients. This review highlights recent findings, describing the use of molecular approaches to monitor, diagnose, and predict alloimmune-mediated injury in kidney grafts.
  
  
  RESULTS
  Both previously identified and newly discovered molecular markers of immune injury have been studied and validated in large multicenter studies. Recent data indicate that measuring specific gene transcripts in noninvasive samples, such as urine or peripheral blood, can identify the occurrence of acute rejection and differentiate this immune-mediated injury from other causes of graft dysfunction. Serial monitoring of urine in stable renal transplant patients may detect the onset of rejection before development of graft dysfunction. Moreover, combining gene expression analysis with conventional histopathologic assessment of grafts can enhance the accuracy of diagnosis and may also help predict graft outcomes.
  
  
  CONCLUSIONS
  Measuring specific gene transcription in noninvasive clinical samples has the potential to become an important and standard tool to monitor alloimmune-mediated injury in kidney transplant recipients. Prospective studies are ongoing to validate these findings for use of these approaches in clinical settings.
authors.affiliation: aDivision of Nephrology, Department of Internal Medicine, Thammasart University, Pathumthani, Thailand bDepartment of Immunology, Lerner Research Institute cDepartment of Nephrology, Glickman Urological Institute, Cleveland Clinic dDepartment of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: Opas
authors.initials: O
authors.lastname: Traitanon
authors.forename: Emilio D
authors.initials: ED
authors.lastname: Poggio
authors.forename: Robert L
authors.initials: RL
authors.lastname: Fairchild
mesh_terms: D000208:Acute Disease; D005819:Genetic Markers; D006084:Graft Rejection / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D035683:MicroRNAs / Q000032:analysis*; D025202:Molecular Diagnostic Techniques; D015166:Monitoring, Immunologic / Q000379:methods*; D011237:Predictive Value of Tests; D012333:RNA, Messenger / Q000032:analysis*; D016896:Treatment Outcome
chemical_list: D005819:Genetic Markers; D007518:Isoantibodies; D035683:MicroRNAs; D012333:RNA, Messenger