Abstract: FR-PO1024
Urinary mRNA Biomarkers for the Noninvasive Diagnosis of Calcineurin Inhibitor Toxicity in Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Pharmacology and Nonkidney Solid Organ Transplants
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Lee, Yu ho, CHA University Bundang Medical Center, Seongnam-si, Gyeonggi-do, Korea (the Republic of)
- Baek, Jihyun, CHA University Bundang Medical Center, Seongnam-si, Gyeonggi-do, Korea (the Republic of)
- Seo, Jung-Woo, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)
- Lee, So-young, CHA University Bundang Medical Center, Seongnam-si, Gyeonggi-do, Korea (the Republic of)
- Jeong, Hye Yun, CHA University Bundang Medical Center, Seongnam-si, Gyeonggi-do, Korea (the Republic of)
- Lee, Sangho, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)
- Hwang, Hyeon Seok, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)
Background
Calcineurin inhibitor (CNI) toxicity is an important cause of graft dysfunction in kidney transplant recipients, yet distinguishing it from acute rejection (AR) and acute tubular necrosis (ATN) remains challenging. This study explores urinary mRNA biomarkers as a non-invasive tool to accurately identify CNI toxicity.
Methods
We retrospectively enrolled 110 kidney transplant recipients and classified them into four groups: stable graft function (n = 35), CNI toxicity (n = 25), acute rejection (n = 30), and acute tubular necrosis (n = 20). Biomarker candidates were identified from the GEO database. Urinary mRNA was extracted from cell pellets, reverse-transcribed, and quantified using real-time PCR.
Results
Four transcripts (LTF, NNMT, WFDC2, and HIF1A) were selected as candidate biomarkers. Urinary LTF, NNMT, and HIF1A levels were significantly lower in CNI toxicity group than in AR group, and NNMT and HIF1A were also lower than in ATN group. WFDC2 levels showed no significant differences across groups. Among single markers, urinary HIF1A best distinguished CNI toxicity from AR and ATN (area under the curve [AUC] = 0.845, p<0.001). Combining LTF, NNMT, and HIF1A further improved diagnostic accuracy (AUC = 0.867, p<0.001).
Conclusion
Urinary mRNA levels of LTF, NNMT, and HIF1A effectively distinguished CNI toxicity from AR and ATN. These findings support their potential as non-invasive diagnostic tools for graft dysfunction in kidney transplant recipients.