A multicenter team of researchers led by Barbara Murphy, M.D., of the Icahn School of Medicine at Mount Sinai has identified a panel of genes that can help predict whether a transplanted kidney will later develop fibrosis, an injury that can cause the organ to fail. Their results were published in the July 21 edition of the journal Lancet.
Researchers in the Genomics of Chronic Allograft Rejection study obtained biopsy samples from transplanted kidneys three months and 12 months after transplantation. Using microarray, a method by which the expression levels of a large numbers of genes or proteins can be measured simultaneously, the researchers determined which genes were correlated with biopsy samples that had an increased Chronic Allograft Damage Index score at the 12-month biopsy. The CADI score is a measure of the level of fibrosis in the transplanted kidney. The researchers then narrowed the genes down to a predictive gene set that identified patients at risk for decline in renal function and loss of the transplanted kidney beyond one year. The rate of correlation of the identified gene set with damage was greater than the clinico-pathological variables currently used in practice to identify kidney transplant recipients at risk for allograft damage and loss.
“This is the first finding of its kind,” said Murphy, system chair of medicine for the Mount Sinai Health System and the Murray M. Rosenberg professor of medicine (Nephrology) at the Icahn School of Medicine at Mount Sinai, and the lead investigator on the study. “By helping us better understand the causes of damage to transplanted kidneys, this study has the potential to change how we monitor and manage all renal transplant patients.”
“The study offers the potential to identify renal transplant recipients at risk for a loss of the new organ prior to the development of irreversible damage,” said Murphy. “This would mean that doctors might eventually have the opportunity to change the therapeutic treatment approach in order to prevent fibrosis from progressing at all.”
Other institutions involved in the study include Westmead Hospital, Sydney, Australia; Northwestern University; Massachusetts General Hospital; Brigham and Women’s Hospital; University of Michigan; and University of Wisconsin.
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the health system has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The system includes approximately 7,000 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is ranked as one of the nation’s top 10 hospitals in geriatrics, cardiology/heart surgery and gastroenterology, and is in the top 25 in five other specialties in the 2015-2016 “Best Hospitals” issue of U.S. News & World Report. Mount Sinai’s Kravis Children’s Hospital also is ranked in seven out of 10 pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for ophthalmology, and Mount Sinai Beth Israel is ranked regionally.