Donor-Derived Cell-Free DNA Parallels Increases in Donor Specific Antibodies in Pediatric Kidney Transplant Recipients.
1Surgery, Stanford University, Palo Alto, CA
2CareDx, Brisbane, CA
Meeting: 2017 American Transplant Congress
Abstract number: D27
Keywords: Antibodies, Kidney transplantation, Pediatric
Session Information
Session Name: Poster Session D: Diagnostics/Biomarkers Session II
Session Type: Poster Session
Date: Tuesday, May 2, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Introduction: Anti-HLA antibody screening is a critical component of post-kidney transplant surveillance. Existing protocols and treatment plans are not standard/consistent across institutions. As increasing numbers of highly sensitized patients are transplanted, the need to understand how best to monitor and treat these patients is crucial.
Methods: Thirteen pediatric kidney transplant recipients were prospectively enrolled at a single center between June 2015 and July 2016. Donor-derived cell-free DNA (dd-cfDNA), protocol donor specific antibody (DSA) monitoring (3, 6, 12 months), and biopsy results were evaluated longitudinally post-transplant. Circulating plasma dd-cfDNA was quantified by an analytically validated clinical-grade next-generation sequencing assay utilizing single nucleotide polymorphisms (SNPs) distributed across the genome to differentiate donor and recipient sequences. Patients with isolated cellular rejection were excluded.
Results: Two patients who developed de novo DSAs post-transplant (either C1q negative or C1q positive) also exhibited significantly elevated dd-cfDNA levels. The single patient with a simultaneous biopsy also demonstrated biopsy-proven antibody mediated rejection (AMR). Elevated dd-cfDNA levels appeared within one month of this histologic change. The difference was statistically significant when compared to those (n=10) without DSA changes (p=0.0046). All patients without de novo DSA production post-transplant exhibited normal (baseline) levels of dd-cfDNA.
Conclusion: dd-cfDNA is a cost effective and convenient test that is associated with de novo DSAs and AMR in pediatric kidney transplant recipients. These data suggest that dd-cfDNA may serve as a novel first line screening tool for AMR and may have the potential to improve transplant outcomes and treatment paradigms.
CITATION INFORMATION: Stoltz D, Brubaker A, Grskovic M, Woodward R, Gallo A. Donor-Derived Cell-Free DNA Parallels Increases in Donor Specific Antibodies in Pediatric Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Stoltz D, Brubaker A, Grskovic M, Woodward R, Gallo A. Donor-Derived Cell-Free DNA Parallels Increases in Donor Specific Antibodies in Pediatric Kidney Transplant Recipients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-derived-cell-free-dna-parallels-increases-in-donor-specific-antibodies-in-pediatric-kidney-transplant-recipients/. Accessed May 25, 2025.« Back to 2017 American Transplant Congress