Published online Dec 24, 2017. doi: 10.5500/wjt.v7.i6.276
Peer-review started: May 23, 2017
First decision: July 20, 2017
Revised: October 16, 2017
Accepted: November 22, 2017
Article in press: November 22, 2017
Published online: December 24, 2017
Processing time: 218 Days and 22.6 Hours
A literature review on immune monitoring in kidney transplantation produced dozens of research articles and a multitude of promising biomarkers, all in the quest for the much sought after - but perennially elusive - “holy grail” of kidney biomarkers able to unequivocally predict acute transplant rejection vs non-rejection. Detection methodologies and study designs were many and varied. Hence the motivation for this editorial, which espouses the notion that in today’s kidney transplantation milieu, the judicious use of disease classifiers tailored to specific patient immune risks may be more achievable and productive in the long run and confer a greater advantage for patient treatment than the pursuit of a single “omniscient” biomarker. In addition, we desire to direct attention toward greater scrutiny of biomarker publications and decisions to implement biomarkers in practice, standardization of methods in the development of biomarkers and consideration for adoption of “biomarker-driven” biopsies. We propose “biomarker-driven” biopsies as an adjunctive to and/or alternative to random surveillance (protocol) biopsies or belated indication biopsies. The discovery of a single kidney transplantation biomarker would represent a major breakthrough in kidney transplantation practice, but until that occurs - if ever it does occur, other approaches offer substantial potential for unlocking prognostic, diagnostic and therapeutic options. We conclude our editorial with suggestions and recommendations for productively incorporating current biomarkers into diagnostic algorithms and for testing future biomarkers of acute rejection in kidney transplantation.
Core tip: In kidney transplantation, a multitude of biomarkers have been proposed to predict transplant rejection vs non-rejection, but few - if any - have gained acceptance as reliable tools for predicting rejection. However, an approach more likely to be successful would include improved timing of kidney transplant biopsies and judicious use of multiple diagnostic methodologies based on different immune risks and events throughout transplantation. This approach could also aid in improving diagnostic and prognostic kidney transplantation algorithms and in developing more impactful therapeutic options.