Unravelling the connections between donor specific antibodies and renal allograft pathology.

The imperfections of early technologies for assessment of human leukocyte antigen (HLA) antibody specificity have been resolved by solid phase micro bead assays, but this has revealed new uncertainties. The relationship between presence of antibody specific for a donor HLA molecule to graft damage and outcomes has had to be re-evaluated. Studies of protocol biopsies have identified a correlation between donor specific antibody and electron microscopy (EM) changes at three months, which do not predict chronic antibody mediated rejection, but that are predicted by EM changes seen on 12-month protocol biopsies.

Transcriptome changes of chronic tubulointerstitial damage in early kidney transplantation.

Background: Tubulointerstitial damage (TID) is a key feature of chronic kidney transplant failure; however, the associated gene expression changes are poorly defined.

Methods: This pilot study used RNA from 59 protocol kidney transplant biopsies at implantation, 1, 3, and 12 months (n=18 patients), processed into cDNA and hybridized to 8K human cDNA microarrays. Gene expression was correlated with graft histology categorized by the Banff schema.

Individualization of immunosuppression: concepts and rationale.

Purpose Of Review: New immunosuppressive agents have decreased the incidence of acute rejection rates without improvement in long-term outcomes. Drug toxicity due to a narrow therapeutic index and individual variations in pharmacokinetics and pharmacodynamics significantly contributes to the inferior outcomes. This review focuses on advances in individualization of immunosuppression therapy using therapeutic drug monitoring and pharmacogenetics/pharmacogenomics as a strategy to minimize toxicity.

Epithelial-to-mesenchymal transition in early transplant tubulointerstitial damage.

It is unknown whether epithelial-to-mesenchymal transition (EMT) leads to tubulointerstitial fibrosis in renal transplants. In this study, interstitial fibrosis and markers of EMT were followed in protocol transplant biopsies in 24 patients. Tubulointerstitial damage (TID) increased from 34 to 54% between 1 and 3 mo after transplantation.

The need for early nephrology referral.

The incidence of end-stage renal disease is increasing. Progression to end stage can be slowed if kidney damage is detected at an early stage. Prognosis and outcomes in patients with chronic kidney disease have been related to the quality of predialysis care and the timing of referral.