Native T۱-Mapping as a Quantitative Biomarker of Renal Allograft Function and Its Relationship with Serum Cytokine Profiles after Paediatric Kidney Transplantation: A Comprehensive Narrative Review

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 T۱-mapping MRI—a non-contrast technique quantifying renal parenchymal microstructure via elevated cortical T۱ 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-۶, TNF-α, CXCL۱۰) and T۱ prolongation, as cytokine-driven inflammation alters tissue relaxation properties detectable by MRI. Native T۱-mapping demonstrates high diagnostic performance for IFTA (sensitivity ۸۱-۸۹%, specificity ۷۸-۸۵%), predicts graft dysfunction (HR ۳.۸ per ۱۰۰ ms T۱ increase), and tracks treatment response. Combined with cytokines, it identifies subclinical rejection with ۹۴% specificity, outperforming eGFR/creatinine.Conclusions: Native T۱-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.

کلیدواژه ها:

Pediatric Kidney Transplantation ، Native T۱-Mapping ، Functional MRI ، Cytokines ، Allograft Monitoring ، Interstitial Fibrosis ، Acute Rejection