Extracellular Vesicles in Kidney Transplantation: A State of the Art Review.

Kidney transplantation is the optimal treatment for patients with end-stage renal disease however, early detection and timely treatment of graft injury remain a challenge. Precise and non-invasive techniques of graft assessment and innovative therapeutics are required to improve kidney transplantation outcomes. Extracellular vesicles (EVs) are lipid bilayer-delimited particles with unique biosignatures and immunomodulatory potential, functioning as intermediaries of cell signalling. Promising evidence exists for the potential of EVs to develop precision diagnostics of graft dysfunction, and prognostic biomarkers for clinician decision making. The inherent targeting characteristics of EVs and their low immunogenic and toxicity profiles combined with their potential as vehicles for drug delivery make them ideal targets for development of therapeutics to improve kidney transplant outcomes. In this review, we summarise the current evidence for EVs in kidney transplantation, discuss common methodological principles of EV isolation and characterisation, explore upcoming innovative approaches in EV research, and discuss challenges and opportunities to enable translation of research findings into clinical practice.