ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: TH-PO1102

A Urinary Metabolite Constellation to Detect Acute Rejection in Kidney Allografts

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Banas, Miriam C., University of Regensburg - Nephrology, Regensburg, Germany
  • Neumann, Sindy, numares AG, Regensburg, Germany
  • Schiffer, Eric, numares AG, Regensburg, Germany
  • Bohmig, Georg, Medical University Vienna, Vienna, Austria
  • Pagel, Philipp, numares AG, Regensburg, Germany
  • Schäffler, Katharina, University of Regensburg - Nephrology, Regensburg, Germany
  • Krämer, Bernhard K., University Hosptal Mannheim, Mannheim, Germany
  • Banas, Bernhard, University of Regensburg - Nephrology, Regensburg, Germany
Background

Post-transplant surveillance for acute rejection is mainly based on regular monitoring of serum creatinine levels and transplant biopsies upon functional renal impairment. Recently, we developed a novel method to detect kidney allograft rejection via a characteristic constellation of the urine metabolites alanine, citrate, lactate, and urea investigated by nuclear magnetic resonance (NMR) spectroscopy (Banas M et al., Metabolomics 2018).

Methods

Within the prospective, observational UMBRELLA study 986 urine specimens were collected from 109 consecutively enrolled renal transplant recipients and metabolite constellations were analyzed by NMR spectroscopy. A metabolite rejection score was calculated and compared to histopathological results of corresponding allograft biopsies (n=206).

Results

The metabolite constellation was found to be a useful biomarker to non-invasively detect acute allograft rejection (AUC = 0.75; 95% confidence interval (CI) 0.68 to 0.83; based on 46 cases with biopsy-proven rejection and 520 controls). A combination of the metabolite rejection score and the estimated glomerular filtration rate (eGFR) at the time of urine sampling further improved the overall test performance significantly (AUC = 0.84; 95% CI 0.76 to 0.91; based on 42 cases and 468 controls). In a subgroup of patients without rejection episodes the test results remained well below a diagnostic threshold associated with high risk of acute rejection. In other cases a marked increase above this threshold indicated an acute allograft rejection already 6-10 days before diagnostic renal biopsies were performed.

Conclusion

In conclusion, a combination of an NMR-based urine metabolite analysis and glomerular filtration rate is promising as a non-invasive test for post-transplant surveillance and to support decision making whether renal allografts need histopathological evaluation.

Funding

  • Commercial Support –