Gene markers can predict fibrosis--and failure--of donor kidneys

By John Murphy, MDLinx
Published July 26, 2016

Key Takeaways

Researchers have found a novel way to identify kidney transplant recipients who are at risk for organ failure. They identified a panel of genes that can predict damaging fibrosis in donor kidneys months before it occurs, according to a July 21, 2016 study in the journal The Lancet.

“This is the first finding of its kind,” said lead investigator Barbara Murphy, MD, Murray M. Rosenberg Professor of Medicine (Nephrology) at the Icahn School of Medicine at Mount Sinai, in New York, NY.

“The study offers the potential to identify renal transplant recipients at risk for a loss of the new organ prior to the development of irreversible damage,” added Dr. Murphy, who is also System Chair of Medicine for the Mount Sinai Health System. “This would mean that doctors might eventually have the opportunity to change the therapeutic treatment approach in order to prevent fibrosis from progressing at all.”

Interstitial fibrosis and tubular atrophy are the major causes of organ failure in the first year after kidney transplantation, but current clinical methods can’t predict this outcome very well.

In this prospective, multi-center investigation—named the Genomics of Chronic Allograft Rejection (GoCAR) study—Dr. Murphy and colleagues aimed to identify a gene set that could predict fibrosis in donor kidneys and their subsequent risk for failure.

The researchers obtained biopsies from 204 patients at 3 months and at 12 months after kidney transplantation. Using microarray analysis, the investigators identified certain genes that correlated with the Chronic Allograft Damage Index (CADI) score at 12 months. Further analysis resulted in a set of 13 genes that independently predicted the development of fibrosis in transplanted kidneys at 1 year.

“Our results suggest that those kidney transplant recipients who are at risk of allograft loss can be identified before the development of irreversible damage, thus offering the potential to modify therapeutic approaches before the onset of fibrosis,” the authors concluded.

“By helping us better understand the causes of damage to transplanted kidneys, this study has the potential to change how we monitor and manage all renal transplant patients,” Dr. Murphy predicted.

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