Translational Health Reports

Abstract Background: Pediatric kidney transplantation is the optimal therapy for end-stage kidney disease in children, yet long-term allograft survival remains inferior to adults due to heightened immunological reactivity, subclinical inflammation, and progressive fibrosis. Conventional monitoring with serum creatinine and protocol biopsies is limited by poor sensitivity and invasiveness.
Methods: This comprehensive narrative review synthesizes evidence on native T1-mapping MRI—a non-contrast technique quantifying renal parenchymal microstructure via elevated cortical T1 and reduced corticomedullary differentiation, reflecting inflammation, oedema, and interstitial fibrosis/tubular atrophy (IFTA)—and its mechanistic interplay with serum cytokine/chemokine profiles capturing alloimmune response phenotypes.
Results: Emerging data show strong pathophysiological/statistical correlations between pro-inflammatory cytokines (especially IL-6, TNF-α, CXCL10) and T1 prolongation, as cytokine-driven inflammation alters tissue relaxation properties detectable by MRI. Native T1-mapping demonstrates high diagnostic performance for IFTA (sensitivity 81-89%, specificity 78-85%), predicts graft dysfunction (HR 3.8 per 100 ms T1 increase), and tracks treatment response. Combined with cytokines, it identifies subclinical rejection with 94% specificity, outperforming eGFR/creatinine.
Conclusions: Native T1-mapping offers robust prognostic value in pediatric renal allografts. Integrated with targeted cytokine panels, it enables biopsy-sparing monitoring, early injury detection, and personalized strategies to improve outcomes. Multicenter trials with standardized protocols are needed.