PMID- 35367023
OWN - NLM
STAT- MEDLINE
DCOM- 20220405
LR  - 20220519
IS  - 1548-5609 (Electronic)
IS  - 1548-5595 (Linking)
VI  - 28
IP  - 6
DP  - 2021 Nov
TI  - Noninvasive Assessment of the Alloimmune Response in Kidney Transplantation.
PG  - 548-560
LID - S1548-5595(21)00076-8 [pii]
LID - 10.1053/j.ackd.2021.08.002 [doi]
AB  - Transplantation remains the optimal mode of kidney replacement therapy, but 
      unfortunately long-term graft survival after 1 year remains suboptimal. The main 
      mechanism of chronic allograft injury is alloimmune, and current clinical 
      monitoring of kidney transplants includes measuring serum creatinine, 
      proteinuria, and immunosuppressive drug levels. The most important biomarker 
      routinely monitored is human leukocyte antigen (HLA) donor-specific antibodies 
      (DSAs) with the frequency based on underlying immunologic risk. HLA-DSA should be 
      measured if there is graft dysfunction, immunosuppression minimization, or 
      nonadherence. Antibody strength is semiquantitatively estimated as mean 
      fluorescence intensity, with titration studies for equivocal cases and for 
      following response to treatment. Determination of in vitro C1q or C3d positivity 
      or HLA-DSA IgG subclass analysis remains of uncertain significance, but we do not 
      recommend these for routine use. Current evidence does not support routine 
      monitoring of non-HLA antibodies except anti-angiotensin II type 1 receptor 
      antibodies when the phenotype is appropriate. The monitoring of both 
      donor-derived cell-free DNA in blood or gene expression profiling of serum and/or 
      urine may detect subclinical rejection, although mainly as a supplement and not 
      as a replacement for biopsy. The optimal frequency and cost-effectiveness of 
      using these noninvasive assays remain to be determined. We review the available 
      literature and make recommendations.
CI  - Copyright (c) 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All 
      rights reserved.
FAU - Filippone, Edward J
AU  - Filippone EJ
AD  - Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at 
      Thomas Jefferson University, Philadelphia, PA. Electronic address: 
      edward.filippone@jefferson.edu.
FAU - Gulati, Rakesh
AU  - Gulati R
AD  - Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at 
      Thomas Jefferson University, Philadelphia, PA.
FAU - Farber, John L
AU  - Farber JL
AD  - Department of Pathology, Sidney Kimmel Medical College at Thomas Jefferson 
      University, Philadelphia, PA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Adv Chronic Kidney Dis
JT  - Advances in chronic kidney disease
JID - 101209214
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Graft Rejection/diagnosis
MH  - Graft Survival
MH  - HLA Antigens
MH  - Humans
MH  - *Kidney Transplantation
MH  - Tissue Donors
OTO - NOTNLM
OT  - Antibody-mediated rejection
OT  - Donor-derived cell-free DNA
OT  - Donor-specific antibodies
OT  - Gene expression profiling
OT  - T-cell mediated rejection
EDAT- 2022/04/04 06:00
MHDA- 2022/04/06 06:00
CRDT- 2022/04/03 20:22
PHST- 2021/04/09 00:00 [received]
PHST- 2021/05/28 00:00 [revised]
PHST- 2021/08/26 00:00 [accepted]
PHST- 2022/04/03 20:22 [entrez]
PHST- 2022/04/04 06:00 [pubmed]
PHST- 2022/04/06 06:00 [medline]
AID - S1548-5595(21)00076-8 [pii]
AID - 10.1053/j.ackd.2021.08.002 [doi]
PST - ppublish
SO  - Adv Chronic Kidney Dis. 2021 Nov;28(6):548-560. doi: 10.1053/j.ackd.2021.08.002.