Even with better immune suppressing drugs being developed for organ transplants, patients still require regular monitoring to prevent graft rejection. Kidney transplant recipients sometimes can be at risk even when standard blood tests for rejection appear stable.
To improve accuracy and avoid the need for frequent biopsies, several teams of transplant specialists are developing new urine tests for diagnosing acute organ rejection. These tests are non-invasive, could be administered often, and could identify immune events in real time.
At the American Transplant Congress this week in San Diego, Jennifer Jackson, MD, a nephrology fellow on the Emory kidney transplant team, presented research on a new urine-based test for the protein osteoprotegerin (OPG) and the chemokines CSCL9 and CXCL10.
Researchers found levels for all three markers elevated in patients experiencing acute rejection, but also in some patients whose grafts were supposedly â€œstable.â€ This smoldering inflammation could be responsible for chronic graft deterioration that goes undetected.
As a result of the study, the researchers are planning a multi-center trial to find out if treatment decisions might be made based on this new test.
â€œIn the future, we might be able to allow our patients to monitor themselves at home and tell us when they need to be seen,â€ says Jackson.
Another team of researchers from several medical centers, including Emory, presented a study of a new test that measures whether certain genes are activated in immune cells present in urine. The team, including Emory Transplant Center clinical director Stuart Knechtle, MD, found that a single urine specimen can be diagnostic for acute rejection and that cell biomarkers could reduce the need for biopsies and associated post-transplant costs and complications.