Donor-specific ELISPOT assay for predicting acute rejection and allograft function after kidney transplantation

Acute rejection remains an important problem after kidney transplantation. Enzyme-linked immunosorbent spot (ELISPOT) assay has been investigated extensively and has shown promising results as a predictor of allograft rejection. The objective of this study was to systematically review and analyze the predictive value of the donor-specific ELISPOT assay to identify recipients at risk for acute rejection. Electronic databases were searched for stud

Urinary extracellular vesicles are a novel tool to monitor allograft function in kidney transplantation

Extracellular vesicles (EVs) are nanoparticles that transmit molecules from releasing cells to target cells. Recent studies link urinary EVs (uEV) to diverse processes such as infection and rejection after kidney transplantation. This, and the unmet need for biomarkers diagnosing kidney transplant dysfunction, has led to the current high level of interest in uEV. uEV provide non-intru-sive access to local protein, DNA, and RNA analytics without invasive biopsy. To determine the added value of uEV measurements for detecting allograft dysfunction after kidney transplantation, we systematically included all related literature containing di

A systematic review and meta-analysis of enzyme-linked immunosorbent spot (ELISPOT) assay for BK polyomavirus immune response monitoring after kidney transplantation

BK virus (BKV) infection after kidney transplantation can cause BKV nephropathy (BKVAN) resulting in graft dysfunction and allograft loss. The treatment for BKVAN is reduction of the immunosuppressive load which increases the risk of kidney transplant rejection. There is no biomarker to monitor BKV activity besides BK viral load. The valu

Monitoring intracellular tacrolimus concentrations and its relationship with rejection in the early phase after renal transplantation

Introduction: After kidney transplantation, rejection and drug-related toxicity occur despite tacrolimus whole blood pre-dose concentrations ([Tac](blood)) being within the target range. The tacrolimus concentration within peripheral blood mononuclear cells ([Tac](cells)) might correlate better with clinical outcomes. The aim of this study was to investigate the correlation between [Tac](blood) and [Tac](cells), the evolution of [Tac](cells) and the [Tac](cells)/[Tac](blood) ratio, and to assess the relationship between tacrolimus concentrations and the occurrence of rejection.Methods: In this prospective study, samples for the measurement of [Tac](blood) and [Tac](cells) were collected on days 3 and 10 after kidney transplantation, and on the morning of a for-cause kidney transplant biopsy. Biopsies were reviewed according to the Banff 2019 update.Results: Eighty-three [Tac](cells) samples were measured of 44 kidney transplant recipients. The correlation between [Tac](cells) and [Tac](blood) was poor (Pearson's r = 0.56 (day 3); r = 0.20 (day 10)). Both the dose-corrected [Tac](cells) and the [Tac](cells)/[Tac](blood) ratio were not significantly different between days 3 and 10, and the median inter-occasion variability of the dose-corrected [Tac](cells) and the [Tac](cells)/[Tac](blood) ratio were 19.4% and 23.4%, respectively (n = 24). Neither [Tac](cells), [Tac](blood), nor the [Tac](cells)/[Tac](blood) ratio were significantly different between patients with biopsy-proven acute rejection (n = 4) and patients with acute tubular necrosis (n = 4) or a cancelled biopsy (n = 9; p > 0.05).Conclusion: Tacrolimus exposure and distribution appeared stable in the early phase after transplantation. [Tac](cells) was not significantly associated with the occurrence of rejection. A possible explanation for these results might be related to the low number of patients included in this study and also due to the fact that PBMCs are not a specific enough matrix to monitor tacrolimus concentrations.Personalised Therapeutic