Grant: Project Grant

End-stage kidney failure (ESKF) is common (38,833 Canadians in 2017), increasing (by 35% since 2008) and costly (more than $1.8 billion/year). Transplantation is the therapy of choice for many patients with better survival and quality of life, and provides healthcare savings of $33,000-$84,000 per patient each year after the first year compared to staying on dialysis. When a patient loses their transplant and returns to dialysis, there is a 3-fold higher risk of dying. Therefore, developing new strategies to keep kidney transplants healthy is a key priority for patients and caregivers. We have identified non-invasive urine tests that can predict late kidney transplant results. We showed that two urine proteins (CCL2 and CXCL10) are elevated 6-months after transplant in patients most likely to lose their transplant. The primary goal of these two large multi-center studies is to independently confirm that these new urine tests predict kidney transplant results, as this is the next critical step to bring these new urine tests into clinical practice. These new urine tests could be used to help personalize transplant care based on individual risk profile. For example, identifying low risk individuals can help doctors decide who may be safe to reduce the amount of anti-rejection medications they are taking. Conversely, high risk patients could be enrolled into clinical trials aimed at improving their long-term transplant health. If these new tests are confirmed as strong predictors of transplant outcome (or "surrogate markers") they could make clinical trials more feasible to conduct. This would help new treatments become available to patients sooner. Finally, these tests may identify low/high risk patients who would benefit from less/more monitoring after transplant. Ultimately, the results from these studies may be used to help inform the design and conduct of the next generation of kidney transplant trials, with the goal of improving kidney transplant results.