Evaluation of new biomarkers
to improve transplant aftercare

Evaluation of new biomarkers

to improve transplant aftercare

Thanks to modern immunosuppressants and intensive follow-up care for transplanted patients, kidney transplantation has developed into a routine procedure that enables patients with terminal kidney failure after transplantation to lead an almost normal life without restrictions. Despite the enormous progress made in recent years, particularly in the early phase after kidney transplantation, chronic kidney transplant loss remains an existing problem.

A particular challenge in transplant aftercare remains the timely detection of incipient transplant damage in order to minimize chronic damage and improve transplant survival through prompt therapeutic measures. Rising serum creatinine, an increase in protein excretion in the urine (proteinuria) or the development of antibodies against the transplant are risk factors that are associated with transplant failure, but are not specific enough to reliably predict transplant failure. In addition, these are often late markers of damage, which limits the success of therapy.

Final clarification of the presence and cause of kidney transplant damage is currently only possible with a transplant biopsy and the histological classification of the material obtained.

This procedure can - despite standardized procedures - lead to complications in rare cases.
For this reason, there has been broad interest in the scientific community for several years now in the establishment of new biomarkers that can be obtained non-invasively and ideally indicate transplant damage before conventional parameters do.

We are currently investigating the benefits of donor-specific, cell-free DNA (dd-cfDNA) as a possible biomarker in transplant aftercare as part of a study in kidney transplant patients with an indication for a transplant biopsy. The release of dd-cfDNA occurs in the context of transplant damage, for example in the event of a rejection reaction. Elevated concentrations of dd-cfDNA can then be detected in the blood and urine. We correlate the concentrations of measured dd-cfDNA with the biopsy result and evaluate whether a possible response to therapy can be recognized by comparing the dd-cfDNA concentrations at different points in time.