Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 24, 2016; 6(1): 28-41
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.28
Proteomics for rejection diagnosis in renal transplant patients: Where are we now?
Wilfried Gwinner, Jochen Metzger, Holger Husi, David Marx
Wilfried Gwinner, Department of Nephrology, Hannover Medical School, 30625 Hannover, Germany
Jochen Metzger, Mosaiques Diagnostics GmbH, 30659 Hannover, Germany
Holger Husi, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, United Kingdom
David Marx, Hôpitaux Universitaires de Strasbourg, Service de Transplantation Rénale, 67091 Strasbourg, France
Author contributions: All authors contributed equally to this paper with conception, literature review and analysis, drafting, critical revision and editing, and approval of the final version.
Supported by The Deutsche Forschungsgemeinschaft, No. GW 4/6-1.
Conflict-of-interest statement: No potential conflict of interest for Wilfried Gwinner, Holger Husi and David Marx; Jochen Metzger is an employee of Mosaiques Diagnostics GmbH which offers services in protein analysis.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wilfried Gwinner, MD, Department of Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. gwinner.wilfried@mh-hannover.de
Telephone: +49-511-5326320 Fax: +49-511-552366
Received: August 14, 2015
Peer-review started: August 15, 2015
First decision: September 28, 2015
Revised: December 14, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: March 24, 2016
Abstract

Rejection is one of the key factors that determine the long-term allograft function and survival in renal transplant patients. Reliable and timely diagnosis is important to treat rejection as early as possible. Allograft biopsies are not suitable for continuous monitoring of rejection. Thus, there is an unmet need for non-invasive methods to diagnose acute and chronic rejection. Proteomics in urine and blood samples has been explored for this purpose in 29 studies conducted since 2003. This review describes the different proteomic approaches and summarizes the results from the studies that examined proteomics for the rejection diagnoses. The potential limitations and open questions in establishing proteomic markers for rejection are discussed, including ongoing trials and future challenges to this topic.

Keywords: Kidney transplantation, Acute rejection, Chronic rejection, T cell-mediated rejection, Antibody-mediated rejection, Long-term outcome, Graft failure, Biopsy, Non-invasive markers, Proteome, Proteomics, Mass spectrometry, Diagnostic marker, Study design, Diagnostic trial

Core tip: Timely detection and treatment of acute and chronic rejection is important to maintain the allograft function in renal transplant patients. Allograft biopsies are unsuitable for continuous monitoring for rejection. This review summarizes the past experience with proteomic approaches to diagnose rejection non-invasively. Potential limitations and open questions in establishing proteomic markers for rejection are discussed, including ongoing trials and future challenges to this topic.