Is urine mRNA analysis a useful tool in the detection of acute rejection?

Abstract

Evaluation of: Suthanthiran M, Schwartz JE, Ding R et al. Urinary-cell mRNA profile and acute cellular rejection in kidney allografts. N. Engl. J. Med. 369(1), 20–31 (2013).

Suthanthiran et al. have correlated the mRNA of more than 4000 urine samples in a blinded fashion with the result of kidney biopsies after transplantation. This was the first study which used mRNA evaluation on a broad scale to investigate acute rejection. This study established an algorithm of different markers which was highly predictive for the outcome of the biopsy retrospectively. The study is highly relevant to the field, but as other studies needs to be validated in a prospective design testing whether the algorithm suggested indeed predicts the result of the biopsy. In the near future, a method such as used in this study could be applied to patients after transplantation as an early follow-up marker.

Keywords::

• acute rejection
• kidney biopsy
• kidney transplantation
• mRNA
• urine analysis

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Urine mRNA may be a useful tool to monitor graft function in patients following kidney transplantation.

• • At present it is still unclear which mRNA should be monitored.

• • In order to evaluate the real significance of urine mRNA as a monitoring tool large scale prospective randomized trials are needed in which a rejection as predicted by urine mRNA testing is afterwards verified by a biopsy.