MicroRNAs hold important roles in the regulation of gene expression. Their function has been correlated with kidney disease and they might represent a new class of biomarkers for frequently evaluating renal graft status. We analyzed their potential in identifying severe T-cell mediated vascular rejection (TCMVR) in kidney transplanted patients. Microarray experiments and real-time RT PCR were performed with RNA from blood cells. Initial microarray analysis revealed 23 differentially expressed microRNAs distinguishing patients with TCMVR from patients with stable grafts. After validation we determined the expression of 6 strongly deregulated microRNAs and two control microRNAs in 97 samples from patients with T-cell mediated rejection (borderline, BANFF I-III), acute and chronic antibody mediated rejection, in 43 samples from stable patients and in 9 samples from patients with urinary tract infection. The panel of 6 microRNAs were significantly down-regulated in blood of TCMVR patients compared to the other groups and displayed high sensitivities (up to 75%) and specificities (up to 98%) for diagnosing vascular rejection by receiver operating characteristics analysis (AUC values up to 0.88). A subsequent multivariate logistic regression showed the diagnostic value by combining five candidate microRNAs thereby obtaining an AUC of 0.97, a sensitivity of 100% and a specificity of 91%. The combined measurement of five specific microRNAs may help to better identify TCMVR after renal transplantation in a precise and clinically applicable way.

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