title: Urinary biomarkers of renal transplant outcome.
abstract: OBJECTIVE
  Renal allograft loss remains an important cause of morbidity and mortality. The objective of this review was to provide a rationale for noninvasive monitoring to identify patients at high risk for graft loss; discuss key steps in prognostic biomarker development from bench-to-bedside; and review promising biomarkers for late renal allograft outcomes.
  
  
  RESULTS
  In a multicentre prospective cohort, early 6-month urinary CCL2 was demonstrated to be associated with the development of 24-month interstitial fibrosis/tubular atrophy and inflammation (IFTA+i). These findings were extended to a single centre cohort, which showed that 6-month urinary CCL2 was a predictor of death-censored graft loss independent of donor-specific antibody and delayed graft function. In a large, multicentre prospective observational study (CTOT-01), 6-month urinary CXCL9 was significantly associated with more than 30% decline of graft function at 24 months.
  
  
  CONCLUSIONS
  Urinary chemokines may identify recipients who are at high risk of graft loss. The early detection of high-risk recipients may allow for more intensive posttransplant surveillance; avoidance of drug minimization/withdrawal protocols; and the identification of patients who may benefit from enrolment in novel interventional trials. Prospective trials are needed to demonstrate that urinary chemokine-guided posttransplant surveillance strategies improve long-term graft outcomes.
authors.affiliation: aSection of Nephrology, Department of Internal Medicine, University of Manitoba bManitoba Centre for Proteomics and Systems Biology, Health Sciences Centre cDepartment of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Ho
authors.forename: David N
authors.initials: DN
authors.lastname: Rush
authors.forename: Peter W
authors.initials: PW
authors.lastname: Nickerson
mesh_terms: D015415:Biomarkers / Q000652:urine; D051799:Delayed Graft Function / Q000209:etiology; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers