Protein biomarkers in renal transplantation

Introduction: The standard of care for monitoring renal transplant patients include transplant biopsy and serum creatinine measurements. These are invasive procedures and are late and nonspecific markers of injury. Proteomics and proteins can provide biomarkers for monitoring pathology and become a useful tool in detection and treatment of conditions that occur after transplant. Areas covered: A survey of 273 studies in the biomarker detection field which included proteomics relating to renal pathology and normal controls was done. Analysis of this data showed pathways and biomarkers specific to different pathologies such as: AR, CR, IRI, TI, VR, DGF, AABMR, ACMR, immunosuppressant toxicity, and infection. It also revealed biomarkers proposed for better detection of these pathologies and the strength (sensitivity and specificity) of such biomarkers. Finally, the field of proteomics in renal transplant in terms of its methodologies, current challenges in clinical translation, and possible solutions are also discussed. Expert commentary: An analysis of biomarkers of acute and chronic rejection revealed acute rejection may be a more inflammatory process. A comparison of proteomic and protein based (n = 183), transcriptomic (n = 1), and genomic (n = 4) studies revealed that proteomic and protein based approaches may offer a clearer picture of inflammation in acute rejection.