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Molecular diagnosis: a bridge to individualized care for the transplant recipient

Purpose of reviewAlthough the therapeutic approach to renal transplantation in the clinic has changed dramatically over the past several decades, the diagnostic approach has not advanced. The purpose of this review is to inform the reader of new advances in molecular diagnosis that are now being tested in ‘blinded’ multicenter trials. Recent findingsThe advent of new transcriptional profiling technologies has facilitated discerning inquiry into the molecular signatures for rejection and for a healthy donor organ. A consistent lab-to-lab molecular signature for acute cellular rejection has been obtained, and progress has been made in determining the molecular basis of healthy and troubled donor organs. SummaryAmplified cytotoxic T cell gene expression is a superb marker for acute cellular rejection, and molecular variants of this basic theme have been identified. Molecular albeit microscopically invisible evidence of inflammation in the donor organ forewarns of compromised clinical outcomes.