Mazandaran Association of Emergency Medicine Translational Health Reports 3092-6750 2 1 2025 12 20 Native T1-Mapping as a Quantitative Biomarker of Renal Allograft Function and Its Relationship with Serum Cytokine Profiles after Paediatric Kidney Transplantation: A Comprehensive Narrative Review 236655 10.22034/thr.2025.564424.1032 EN Ahmad Deylami Department of Urology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran Shahabaldin Bagheri 2. Department of General Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran Zia Hejripour Trauma and Surgery Research Center, AJA University of Medical Sciences, Tehran, Iran Department of Emergency Medicine, AJA University of Medical Sciences, Tehran, Iran Amirsaleh Abdollahi Student Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran Behkam Rezaiemehr Department of Urology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran Mohammad Javad Bay Student Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran Mehdi Younesi Rostami Department of Urology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran Hossein Meskar Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran Journal Article 2025 12 05 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.

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