Clinical Utility of Donor-Derived Cell-Free DNA During the Period of Recovery of Renal Function After Kidney Transplantation

Y. C. Dreige¹, G. Bittencourt Pereira Lima¹, M. Cristelli¹, M. Nakamura¹, R. D. Foresto¹, P. Pierry¹, R. Ponsirenas², J. Levi¹, J. Medina¹, H. Tedesco¹

¹Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil, ²Medical Affairs, CareDx, Miami, FL

Meeting: 2022 American Transplant Congress

Abstract number: 1586

Keywords: Kidney transplantation

Topic: Basic Science » Basic Clinical Science » 17 - Biomarkers: Clinical Outcomes

Session Information

Session Name: Biomarkers: Clinical Outcomes

Session Type: Poster Abstract

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: This study evaluates the clinical utility of monitoring donor-derived cell-free DNA (dd-cfDNA), a biomarker of kidney injury, in recipients of high Kidney Donor Profile Index (KDPI) transplants during the period of kidney function recovery.

*Methods: This is a single-center, prospective, cohort study in recipients of high KDPI kidneys who developed delayed graft function (DGF), defined as the need for dialysis within the first week after transplantation. All patients received a single 3 mg/kg anti-thymocyte globulin dose, tacrolimus, mycophenolate, and prednisone. Blood samples were obtained at 14 (D14) and 30 (D30) days to measure the percentage (%) of dd-cfDNA. The dd-cfDNA > 1% is associated with an increased probability for acute rejection (AR).

*Results: This preliminary analysis includes data from 69 patients. The median KDPI was 73% [IQR 47-87] and the mean cold ischemia time was 27± 7 hours. The incidence of DGF was 89.8% with a median duration of 6 (IQR 2 – 9) days. At D14 the median GFR was 12 ml/min/1.73 m² (IQR 6-21) and the median dd-cfDNA levels were 0.43% (IQR 0.02-0.78), with 19 patients (28%) showing dd-cfDNA >1%. Surveillance biopsies during DGF were performed in 42 (61%) patients showing one T-cell mediated rejection IA (dd-cfDNA of 0.41%) and 4 borderline changes (dd-cfDNA 0.82%, 0.85%, 0.98%, 1.90%). Using dd-cfDNA >1% to guide the indication of the surveillance biopsy, we would have avoided 22 (52%) biopsies but missed 1 (2%) patient with AR. At D30, the median GFR was 36 ml/min/1.73 m² (IQR 28-48) and the median dd-cfDNA levels were 0.40% (IQR 0.01-0.66), with 12 patients (19%) showing dd-cfDNA >1%. Surveillance biopsies performed in 21 (30.43%) patients with incomplete recovery of kidney function showed 4 borderline changes (dd-cfDNA 0.17%, 0.66%, 0.67%, and 2.80%). Using dd-cfDNA >1% to guide the indication of the surveillance biopsy, we would have avoided 12 (57%) biopsies without missing any AR episodes. Overall, 5 (7%) patients showed dd-cfDNA >1% at D14 and D30, but none of them showed biopsy confirmed AR.

*Conclusions: This preliminary analysis suggests that monitoring dd-cfDNA may assist clinical decisions during the period of DGF and in kidney transplant recipients with incomplete recovery of graft function.

To cite this abstract in AMA style:

Dreige YC, Lima GBittencourtPereira, Cristelli M, Nakamura M, Foresto RD, Pierry P, Ponsirenas R, Levi J, Medina J, Tedesco H. Clinical Utility of Donor-Derived Cell-Free DNA During the Period of Recovery of Renal Function After Kidney Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-utility-of-donor-derived-cell-free-dna-during-the-period-of-recovery-of-renal-function-after-kidney-transplantation/. Accessed May 18, 2025.

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