Abstract：Objective: Since acute rejection remains one of the major complications which necessitate periodic surveillance, noninvasive diagnostic/prognostic methods are preferred by renal transplant recipients. Here, we explored whether urinary C-X-C motif chemokines 13 (CXCL13) could be a potential candidate to reflect ongoing immune processes within the renal graft. Methods: We investigated urinary CXCL13 levels by a cross-sectional analysis of 146 renal allograft recipients and 40 healthy controls. Besides, a subset of patients (n=57) were followed-up for kinetic monitoring of immune status. Results: Urinary CXCL13/Cr was lower in normal transplants compared to those with acute tubular necrosis (ATN, P=0.001), chronic allograft nephropathy (CAN, P=0.01) and acute rejection (AR, P<0.0001), which yielded a good diagnosis performance of urinary CXCL13 for AR (AUC=0.818, P<0.0001). Interestingly, urinary CXCL13 further distinguished acute antibody mediated rejection (ABMR) from acute cellular rejection, with an AUC of 0.856. Besides, patients with steroid-resistant acute rejection had distinctly greater urinary CXCL13/Cr levels than patients with reversible acute rejection, P=0.001. Follow-up data revealed that urinary CXCL13/Cr varied in line with the occurrence of ABMR. Furthermore, elevated levels of urinary CXCL13/Cr within the first month was predictive of graft function at 3, 6 months, P=0.044 and 0.4. Conclusion: This study demonstrates that monitoring of urinary CXCL13/Cr might be a valuable noninvasive approach for the detection of AR, especially ABMR. Additionally, high urinary CXCL13/Cr levels related to the poor response to steroid treatment and predicted a compromised graft function after AR.
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