Advances in Detection of Kidney Transplant Injury

  • Sanjeeva Herath
  • Jonathan Erlich
  • Amy Y. M. Au
  • Zoltán H. EndreEmail author
Review Article


Early detection of graft injury after kidney transplantation is key to maintaining long-term good graft function. Graft injury could be due to a multitude of factors including ischaemia reperfusion injury, cell or antibody-mediated rejection, progressive interstitial fibrosis and tubular atrophy, infections and toxicity from the immunosuppressive drugs themselves. The current gold standard for assessing renal graft dysfunction is renal biopsy. However, biopsy is usually late when triggered by a change in serum creatinine and of limited utility in diagnosis of early injury when histological changes are equivocal. Therefore, there is a need for timely, objective and non-invasive diagnostic techniques with good early predictive value to determine graft injury and provide precision in titrating immunosuppression. We review potential novel plasma and urine biomarkers that offer sensitive new strategies for early detection and provide major insights into mechanisms of graft injury. This is a rapidly expanding field, but it is likely that a combination of biomarkers will be required to provide adequate sensitivity and specificity for detecting graft injury.


Compliance with Ethical Standards

Conflict of interest

ZHE has received travel support from Ortho Diagnostics, Roche Pharmaceuticals and the Novartis Australian Renal Transplant Advisory Board. SH, JE and AYMA declare that they have no conflicts of interest.


ZHE has received research funding from the Australian National Health and Medical Research Council and the New Zealand Health Research Council. SH has received funding from the Prince of Wales clinical school scholarship, Australia.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sanjeeva Herath
    • 1
  • Jonathan Erlich
    • 1
  • Amy Y. M. Au
    • 1
    • 2
  • Zoltán H. Endre
    • 1
    • 2
    Email author
  1. 1.Prince of Wales Clinical SchoolUniversity of New South WalesRandwickAustralia
  2. 2.Department of NephrologyPrince of Wales HospitalSydneyAustralia

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