Abstract：
BACKGROUND: Long-term outcomes in pediatric kidney transplantation remain suboptimal, largely related to chronic rejection. Creatinine is a late marker of renal injury, and more sensitive, early markers of allograft injury are an active area of current research.
METHODS: This is an educational review summarizing existing strategies for monitoring for rejection in kidney transplant recipients.
RESULTS: We summarize supporting currently available clinical tests, including surveillance biopsy, donor specific antibodies, and donor-derived cell free DNA, as well as the potential limitations of these studies. In addition, we review the current avenues of active research, including transcriptomics, proteomics, metabolomics, and torque tenovirus levels.
CONCLUSIONS: Advancing the use of noninvasive immune monitoring will depend on well-designed multicenter trials that include patients with stable graft function, include biopsy results on all patients, and can demonstrate both association with a patient-relevant clinical endpoint such as graft survival or change in glomerular filtration rate and a potential timepoint for intervention.
METHODS: This is an educational review summarizing existing strategies for monitoring for rejection in kidney transplant recipients.
RESULTS: We summarize supporting currently available clinical tests, including surveillance biopsy, donor specific antibodies, and donor-derived cell free DNA, as well as the potential limitations of these studies. In addition, we review the current avenues of active research, including transcriptomics, proteomics, metabolomics, and torque tenovirus levels.
CONCLUSIONS: Advancing the use of noninvasive immune monitoring will depend on well-designed multicenter trials that include patients with stable graft function, include biopsy results on all patients, and can demonstrate both association with a patient-relevant clinical endpoint such as graft survival or change in glomerular filtration rate and a potential timepoint for intervention.
摘要：
背景：小儿肾移植的长期结局仍不理想，主要与慢性排斥反应有关。肌酐是肾损伤的晚期标志，更敏感，同种异体移植损伤的早期标志物是目前研究的一个活跃领域。
方法：这是一个教育性综述，总结了现有的监测肾移植受者排斥反应的策略。
结果：我们总结了支持当前可用的临床试验，包括监测活检,供体特异性抗体，和供体来源的无细胞DNA，以及这些研究的潜在局限性。此外,我们回顾了当前积极研究的途径，包括转录组学，蛋白质组学，代谢组学，和扭矩tenovirus水平。
结论：推进非侵入性免疫监测的应用将取决于精心设计的多中心试验，包括具有稳定移植物功能的患者，包括所有患者的活检结果，并且可以证明与患者相关的临床终点如移植物存活或肾小球滤过率变化以及潜在的干预时间点相关。
方法：这是一个教育性综述，总结了现有的监测肾移植受者排斥反应的策略。
结果：我们总结了支持当前可用的临床试验，包括监测活检,供体特异性抗体，和供体来源的无细胞DNA，以及这些研究的潜在局限性。此外,我们回顾了当前积极研究的途径，包括转录组学，蛋白质组学，代谢组学，和扭矩tenovirus水平。
结论：推进非侵入性免疫监测的应用将取决于精心设计的多中心试验，包括具有稳定移植物功能的患者，包括所有患者的活检结果，并且可以证明与患者相关的临床终点如移植物存活或肾小球滤过率变化以及潜在的干预时间点相关。
