Over 16,000 end-stage renal disease (ESRD) patients undergo kidney transplantation in the United States every year. For most ESRD patients, successful kidney transplantation provides longer survival and a better quality of life than dialysis.
[Photo: Dr. Kellie Archer]
Yet, waiting lists and waiting times for kidney transplants continue to grow in the United States. This is due, in part, to potentially viable kidney organs being discarded because they were assessed using the traditional histological biopsy result, which has now been shown to not be predictive of post-transplant outcomes.
In order to find a more accurate predictor of which kidney transplants will be successful and which ones will fail, the National Institute of Health (NIH), has awarded co-principal investigators Dr. Kellie Archer, chair of the biostatistics division at The Ohio State University College of Public Health, and Dr. Valeria Mas, associate professor of surgery and director of the Translational Genomics Transplant Laboratory at University of Virginia School of Medicine, a $2,008,527 four-year grant designed to “identify and validate molecular biomarkers capable of evaluating diseased donor (DD) organ quality predictive of short- and long-term kidney graft function.”
“A balance between organ acceptance and discard rates has been difficult to achieve given a lack of precise tools capable of assessing donor kidney quality predictive of outcomes,” Dr. Archer said. “In fact, deceased donor (DD) kidneys retrieved for transplantation are increasingly being discarded, and the most common reason given for discarding kidneys is histological biopsy results.
“However, two recent studies suggest that histological evaluation of procurement biopsies are not predictive of post-transplant outcomes,” Dr. Archer said. “This implies the current practice of relying on histological biopsy results of DD kidneys may dissuade the use of kidneys that are otherwise suitable for transplant.”
This project, funded by the National Institute of Diabetes, Digestive and Kidney Diseases, will use a unique matched donor/recipient cohort of 548 DD primary kidney transplant recipients from four different institutions (Virginia Commonwealth University, University of Virginia, Albert Einstein College of Medicine, and University of Manitoba).
According to Dr. Archer, “high-throughput molecular assays to examine gene expression, microRNA expression, and DNA methylation, will be performed on longitudinally collected samples in this cohort to identify molecular markers indicative of donor quality and predictive of post-transplant outcomes.”