Molecular diagnosis of antibody-mediated rejection in human kidney transplants.

摘要: Antibody-mediated rejection is the major cause of kidney transplant failure, but histology-based diagnostic system misses most cases due to its requirement for C4d positivity. We hypothesized that gene expression data could be used test biopsies presence antibody-mediated rejection. To develop a molecular test, we prospectively assigned diagnoses, including C4d-negative rejection, 403 indication from 315 patients, based on histology (microcirculation lesions) and donor-specific HLA antibody. then microarray classifiers scores each biopsy. The transcripts distinguishing other conditions were mostly expressed in endothelial cells or NK cells, IFNG-inducible. correlated with microcirculation lesions Of 45 >0.5, 39 had been diagnosed as basis High also associated unanimity among pathologists was present. score strongly predicted future graft loss Cox regression analysis. conclude assessment can assign probability ABMR without knowledge antibody status, histology, staining, predicts failure.