Pretransplant characteristics of kidney transplant recipients that predict posttransplant outcome

Abstract

Better characterization of the potential kidney transplant recipient using novel biomarkers, for example, pretransplant plasma endotrophin, will lead to improved outcome after transplantation. This mini-review will focus on current knowledge about pretransplant recipients' characteristics, biomarkers, and immunology. Clinical characteristics of recipients including age, obesity, blood pressure, comorbidities, and estimated survival scores have been introduced for prediction of recipient and allograft survival. The pretransplant immunologic risk assessment include histocompatibility leukocyte antigens (HLAs), anti-HLA donor-specific antibodies, HLA-DQ mismatch, and non-HLA antibodies. Recently, there has been the hope that pretransplant determination of markers can further improve the prediction of posttransplant complications, both short-term and long-term outcomes including rejections, allograft loss, and mortality. Higher pretransplant plasma endotrophin levels were independently associated with posttransplant acute allograft injury in three prospective European cohorts. Elevated numbers of non-synonymous single-nucleotide polymorphism mismatch have been associated with increased allograft loss in a multivariable analysis. It is concluded that there is a need for integration of clinical characteristics and novel molecular and immunological markers to improve future transplant medicine to reach better diagnostic decisions tailored to the individual patient.

Keywords: acute allograft injury; biomarker; endotrophin; immunology; kidney transplantation; potential kidney transplant recipient; precision transplant medicine; rejection.

Figure 1

Steps toward the future integration of a predictive biomarker to evaluate potential kidney transplant recipients. A simplified scheme for investigations required to improve future transplant medicine and to reach precision medicine is shown. Outcome may indicate a large spectrum of paraclinical or clinical endpoints, for example (but not limited to), glomerular filtration rate, loss of allograft, infections, hypertension, immunosuppression, acute allograft injury, rejection episodes, or patient-reported outcome measures. Examples for outcome variables’ timing (years) are shown but may be adopted according to appropriate study plans. Tx indicates transplantation.