Evaluating the accuracy of functional biomarkers for detecting histological changes in chronic allograft nephropathy

Serdar Yilmaz, Ipek Isik, Marjan Afrouzian, Mauricio Monroy, Aylin Sar, Hallgrimur Benediktsson, Kevin McLaughlin

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


The most common cause of late kidney transplant failure is chronic allograft nephropathy (CAN). Much research has focused on identifying biomarkers (or correlates) that would predict subsequent CAN and allow timely intervention. Functional biomarkers such as serum creatinine and estimated glomerular filtration rate (eGFR) have been widely adopted, even though they have not been rigorously evaluated as surrogate markers. This study evaluated serum creatinine and eGFR for predicting the early histopathological changes seen in transplant protocol biopsies (TPB). We prospectively followed 289 kidney transplant patients in the Southern Alberta Transplant Program who had TPB at 6-12 months post-transplant. Tissue samples (n = 280) were independently examined by renal pathologists. The ability of serum creatinine or eGFR to predict the threshold level for abnormal histopathology was evaluated by calculating the area under the receiver operator characteristic curve. Serum creatinine and eGFR had poor predictive value (most confidence intervals included 0.5, indicating no predictive ability) for ten individual histological measurements (Banff 97 scores), and the Chronic Allograft Damage Index. We conclude that serum creatinine and eGFR have a limited clinical role in predicting the early histopathological changes that precede CAN and should not be used for this purpose.

Original languageEnglish (US)
Pages (from-to)608-615
Number of pages8
JournalTransplant International
Issue number7
StatePublished - Jul 2007
Externally publishedYes


  • Chronic allograft damage index
  • Chronic allograft nephropathy
  • Estimated glomerular filtration rate
  • Protocol biopsy
  • Receiver operator characteristic curve analysis
  • Serum creatinine
  • Surrogate marker

ASJC Scopus subject areas

  • Transplantation


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