This chapter reviews the evolving knowledge regarding biomarkers of kidney allograft rejection and tolerance. The development of noninvasive diagnostic and prognostic biomarkers for allograft rejection and for allograft tolerance is critical to the advancement of transplant medicine. Biomarkers related to the functional attributes of T cells, B cells, and innate cells have shown great promise in predicting transplant outcomes in selected cohorts of patients. Biomarker validation is strengthened by data from large-scale clinical trials. Despite the recent gains from biomarker discovery and validation related to acute T cell-mediated rejection, biomarkers diagnostic of humoral/antibody-mediated rejection remain to be fully defined. Biomarker signature discovery by cross-platform composite efforts from RT-PCR to microarray and flow cytometry may improve the accuracy and predictive values for diagnosing allograft rejection and tolerance. The benchmark of obtaining a serum creatinine measurement is both intuitively and in practice faster than ordering a biomarker test to diagnose allograft dysfunction.
- Acute T cell-mediated rejection
- Allograft dysfunction
- Allograft tolerance
- Flow cytometry
- Humoral/antibody-mediated rejection
- Kidney allograft rejection
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