Molecular methods in non-invasive diagnosis of acute rejection in kidney transplants

Abstract

Kidney transplantation is the treatment of choice for many end-stage kidney disease patients. Acute rejection remains a significant complication, and the graft biopsy is still the gold diagnostic standard. As it is invasive and potentially harmful, there are searches for new markers to diagnose such condition. Non-invasive diagnostic tools have several advantages mainly including possibility of frequent and sequential use to easily assess the immune status of the receptor. This review presents the methods and advantages of the molecular approaches currently used in researching kidney transplantation, real time polymerase chain reaction, DNA micro- arrays, and more recently, micro-RNAs analyzes. It is expected that microarrays and micro-RNAs may attain a crucial role to the organ transplantation in matters related to the identification of molecular mechanisms of acute rejection, chronic injury, effect of immunosuppressive drug toxicity and tolerance. The development of molecular techniques capable of noninvasively provide a panel for the immunological activity mediating injury to the graft suggests possibility of optimization and individualization of the immu- nosuppressive therapy. For this review, we used searching tools on international databases (PubMed, Web of Knowledge) through the descriptors “Kidney transplantation”, “Graft Rejection” and “Diagnostic Techniques and Procedures”. We selected only studies from indexed journals and referred to studies of major clinical or historical importance in the area.