*Purpose: Acute Rejection remains a significant complication in kidney transplantation that affects long-term outcomes. Using a large collection of gene expression data obtained from multiple public databases, we developed a peripheral blood gene expression signature of acute rejection that could be used in both pediatric and adult recipients.

*Methods: We compiled transplant renal biopsy (n=1091) and peripheral blood cell (n=392) gene expression profiles obtained from 12 independent public databases. After removing genes differentially expressed in children and adults, we developed a gene signature of acute rejection from renal and peripheral blood cells using adult samples and validated this signature in an independent pediatric dataset. We further validated this novel acute rejection signature using patient (age 1-78) samples from our institutional biorepository with 1 year follow up.

*Results: We observed substantial gene expression differences between adult and pediatric cases with acute rejection (Panel 1). We revealed an age-independent gene set that was associated with acute rejection in both renal and peripheral blood cells and validated in our institutional cohort (Panel 2).

*Conclusions: This study serves as a novel model of using public datasets to rapidly screen and validate biomarkers. This peripheral signature of acute rejection will allow for improved monitoring of allografts in pediatric patients as they progress to adulthood allowing for immunosuppression titration and improvement in long-term outcomes.

« Back to 2019 American Transplant Congress