Transplant International (Oct 2023)

Assessment of Donor Derived Cell Free DNA (dd-cfDNA) at Surveillance and at Clinical Suspicion of Acute Rejection in Renal Transplantation

  • Evangelos Mantios,
  • Vassilis Filiopoulos,
  • Pantelis Constantoulakis,
  • George Liapis,
  • Angeliki Vittoraki,
  • Silvia Casas,
  • Smaragdi Marinaki,
  • John N Boletis

DOI
https://doi.org/10.3389/ti.2023.11507
Journal volume & issue
Vol. 36

Abstract

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In our prospective, unicenter cohort study, we collected blood samples from 30 newly kidney transplanted patients, at month 1, 2, 3, and 5 for dd-cfDNA analysis, along with creatinine/eGFR and DSA monitoring, and from 32 patients who underwent an indication biopsy and whose dd-cfDNA levels were measured at the time of biopsy and 1 month afterwards. Fourteen of 32 (43.8%) patients in the biopsy group were diagnosed with TCMR and 5 of 32 (15.6%) with ABMR. Dd-cfDNA proved to be better than creatinine in diagnosing rejection from non-rejection in patients who were biopsied. When a dd-cfDNA threshold of 0.5% was chosen, sensitivity was 73.7% and specificity was 92.3% (AUC: 0.804, 0.646–0.961). In rejection patients, levels of dd-cfDNA prior to biopsy (0.94%, 0.3–2.0) decreased substantially after initiation of treatment with median returning to baseline already at 1 month (0.33%, 0.21–0.51, p = 0.0036). In the surveillance group, high levels of dd-cfDNA (>0.5%) from second month post-transplantation were correlated with non-increasing eGFR 1 year post-transplantation. The study used AlloSeq kit for kidney transplant surveillance for first time and confirmed dd-cfDNA’s ability to detect rejection and monitor treatment, as well as to predict worse long-term outcomes regarding eGFR.

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