2025 年 32 巻 2 号 p. 061-066
How to identify and overcome delayed graft function (DGF) and primary non-function (PNF) from marginal donors are a major clinical issue. Comprehensive gene expression analysis of renal transplant biopsies from rat brain-dead kidney transplant models and kidneys from DCD transplants revealed increased expression of cytokines, chemokines, and adhesion molecules. In the analysis of DCD transplants biopsy, the expression of complement pathways was upregulated in the DCD group, and the expression of metabolic pathways such as various amino acids and lipids was downregulated in the DCD. We focused on secreted proteins with elevated gene expression and developed a measurable biomarker for clinical application. NGAL, TIMP-1, and L-FABP in post-transplant serum showed significant changes in the DCD group, and NGAL and L-FABP are currently attracting attention as biomarkers for AKI, and their measurement in urine is covered by insurance. The concept of liquid biopsy has recently been proposed for biomarker development and is expected to be applied not only in the field of oncology but also in the field of transplantation. In DCD group, there is a significant change in blood total cell-free DNA after renal transplantation. Reports from the field of DCD renal transplantation, in which we have been involved, have led to the introduction of new techniques such as machine perfusion (MP) that avoid PNF and reduce ATN.
