Predicting kidney rejection in paediatric kidney patients

09 September 2022

Although dialysis is a treatment option for kidney failure, the best treatment is a kidney transplant. This is true for adults and for children. After a kidney is transplanted, kidney rejection may occur. This is usually because the immune system of the patient naturally assumes that the new kidney is foreign and attacks it. This can be quite devastating for the patient and currently, the best way to minimise the risk of rejection is to put children on medications to suppress the immune system. This is a double-edged sword because although they can reduce the risk of kidney rejection, they also suppress the child’s immunity, making them more prone to infection and diseases.

We know that the earlier rejection is detected, the better it is managed. Routine screening post transplantation is performed with blood tests, including measurement of creatinine levels but many patients do not have symptoms, and by this time it is elevated and may be too late. The “gold standard” method of detecting rejection which involves an operation to remove a very small piece of the kidney to assess its health, is invasive with possibility of complications. It may not be representative of the whole kidney and usually requires an anaesthetic for young children. It is therefore important to develop methods that detect the possibility of kidney rejection early and efficiently.

Professor Stephen Marks

The solution

Professor Stephen Marks from University College London and Great Ormond Street Institute of Child Health will employ a research student to work towards finding new biomarkers that point towards the possibility of kidney rejection before it happens. These biomarkers are expected to be non-invasive and have diagnostic and prognostic value. This means that they should be able to not only spot, but also predict kidney rejection ahead of it happening.

They will use immune cells from paediatric kidney transplant recipients where rejection has occurred and perform a process known as RNA sequencing. They will then match the results from sequencing with clinical characteristics of the patient to potentially identify patterns and correlations. They will also carry out a cross-sectional study to validate their results using a range of patients' samples such as urine, blood and biopsy material. Finally, among patients undergoing transplants, they will assess and validate the ability of the developed biomarker to predict kidney rejection.

What this might mean for kidney patients

If a biomarker is identified and found to be effective, this could be pivotal for children who have received kidney transplants. Monitoring the health of their kidneys could be made easier, and detection of possible kidney failures could be performed faster and even predicted. This could also help avoid the invasiveness of a kidney transplant biopsy, ultimately transforming the management of paediatric kidney transplant recipients.

Professor Stephen Marks said: “I am honoured and thrilled to be the recipient of the Laurence Isaacson Award which we will use to improve the lives of children and young people who have irreversible kidney failure requiring kidney transplantation. The public perception is that kidney transplantation is a cure, but they have a limited lifespan and children, and young people usually require more than one kidney transplant during their lives. This award will help us identify better ways of detecting kidney injury which hopefully means we could treat rejection earlier and makes these kidney transplants last longer.”