Intragraft gene expression can predict graft loss

In an article just published in 'Journal of Clinical Investigation' (Einecke et al, JCI: June 2010), intragraft molecular signature was found to predict late graft loss. Authors perfomed microarrays to analyze gene expression in 105 'for-cause' biopsies taken 1 to 31 years after kidney transplantation. Based on this, authors derived a molecular risk score (comprising of 30 genes related to tissue injury, epithelial dedifferentiation, matrix remodelling and TGF-beta) that was associated with future graft failure. This molecular risk score was superior to classical features associated with progression to renal failure (histological findings, proteinuria and low eGFR at the time of biospy) in predicting incipient graft loss. The main limitation of this study is that it was not a prospective study. However, the important point here is that intragraft gene expression studies will likely help us in prognosticating, identifying pathogenic mechanisms, initiate specific therapy if available (personalized therapy rather than one-size-fits-all approach) and develop potential new therapies.