Pretransplant transcriptomic signature in peripheral blood predicts early acute rejection
Zhang W, Yi Z, Wei C, Keung KL, Sun Z, Xi C, Woytovich C, Farouk S, Gallon L, Menon MC, Magee C, Najafian N, Samaniego MD, Djamali A, Alexander SI, Rosales IA, Smith RN, O'Connell PJ, Colvin R, Cravedi P, and Murphy B. Pretransplant transcriptomic signature in peripheral blood predicts early acute rejection. JCI Insight 2019; 4(11).
Commonly available clinical parameters fail to predict early acute cellular rejection (EAR, occurring within 6 months after transplant), a major risk factor for graft loss after kidney transplantation. We performed whole-blood RNA sequencing at the time of transplant in 235 kidney transplant recipients enrolled in a prospective cohort study (Genomics of Chronic Allograft Rejection [GoCAR]) and evaluated the relationship of pretransplant transcriptomic profiles with EAR. EAR was associated with downregulation of NK and CD8+ T cell gene signatures in pretransplant blood. We identified a 23-gene set that predicted EAR in the discovery (n = 81, and AUC = 0.80) and validation (n = 74, and AUC = 0.74) sets. Exclusion of recipients with 5 or 6 HLA donor mismatches increased the AUC to 0.89. The risk score derived from the gene set was also significantly associated with acute cellular rejection after 6 months, antibody-mediated rejection and/or de novo donor-specific antibodies, and graft loss in a cohort of 154 patients, combining the validation set and additional GoCAR patients with surveillance biopsies between 6 and 24 months (n = 80) posttransplant. This 23-gene set is a potentially important new tool for determination of the recipient's immunological risk before kidney transplantation, and facilitation of an individualized approach to immunosuppressive therapy.