Kidney transplantation is the treatment of choice for patients suffering end-stage renal disease because it provides better quantity and quality of life than other means of renal replacement therapy.
Despite tremendous advances in the medical and surgical management of these patients, the short- and long-term success of this procedure is still not ideal. Therefore, the research and clinical transplant communities are engaged in a constant effort to further understand and learn the underlying biological mechanisms that preclude the desired outcomes.
Advances in the scientific field are constant but slow, and there is an increasing interest in studying new noninvasive biomarkers that will help the clinician predict or prevent poor outcomes, providing new opportunities for early interventions or development of new therapeutic strategies.
Novel biomarkers and techniques are rapidly emerging in the field of basic kidney transplantation research; however, translation into human research is lacking. Some of these biomarkers have been studied and are close to routine clinical implementation, but the vast majority is at different stages of development and is not yet available.
Furthermore, these new biomarkers are still to be measured and validated in large cohorts of kidney transplant recipients. The advent of new techniques to study the pathogenesis of immune-mediated injury, such as organ transplant rejection, will require repetitive tissue sampling in a large cohort of patients to assess their potential clinical application to patient care.
A large number of human samples and state-of-the-art laboratories are required to test and validate these biomarkers and to study mechanisms of disease. Thus, there is a need to systematically collect samples and store those samples in biobanks/biorepositories for future investigations.
To accomplish this, we need state-of- the-art infrastructure, professional expertise and a large number of transplant recipients from whom samples can be obtained, all of which is available at Cleveland Clinic. The Renal Transplant Program has established this needed biorepository, which we have named the Renal Transplant BioBank.
The goal of the Renal Transplant BioBank is to establish a patient-linked biologic sample repository (blood, urine and graft histology) for use in future research studies related to metabolic, inflammatory and immunologic markers relevant to organ transplantation. However, the first step is to build up the repository, which is labor-intensive and costly.
In collaboration with the Lerner Research Institute, the Kidney and Pancreas Transplant Program—with financial support provided by the Novick Center for Research and Education in the Glickman Urological and Kidney Institute—has initiated the collection and storage of biospecimens (blood, urine, biopsy tissue) from kidney and pancreas transplant recipients who receive an organ at Cleveland Clinic. The collection is initiated after the patient has provided informed consent.
These biospecimens are intended to be used in the future to develop and test novel biomarkers that will eventually translate into better patient care. This is one of the most relevant endeavors in the research arena of the program due to its potential future application. Importantly, this is a unique initiative that is possible only in a few medical centers in the U.S.
Finally, the experience gained in this endeavor will be the basis for future expansion of this type of biorepository to other areas in kidney disease.
Emilio D. Poggio, MD, FASN, is an Associate Staff in the Department of Nephrology and Hypertension in Cleveland Clinic’s Glickman Urological and Kidney Institute.