Donor-derived Cell-free Dna In Donor Specific Antibody Positive Kidney Transplant Recipients

D. Cheng¹, X. Li², T. Jiang², H. Liu², Y. Zhou³, H. Shi³

¹National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China, ²Research and Development, AlloDx Biotech Co.Ltd., Suzhou, China, ³Precise Medicine Center, Biology and Science School, JiangSu University, Zhenjiang, China

Meeting: 2019 American Transplant Congress

Abstract number: A24

Keywords: Genomic markers, Kidney transplantation, Medicare, Rejection

Session Information

Session Name: Poster Session A: Acute Rejection

Session Type: Poster Session

Date: Saturday, June 1, 2019

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall C & D

*Purpose: Donor-derived cell-free DNA (dd-cfDNA) is an emerging biomarker of kidney allograft injury. Studies examining the clinical validity of this biomarker have identified cut off values for kidney allograft rejection: <1% of dd-cfDNA level reﬂect the absence of active rejection (T cell-mediated type >IA or ABMR) and >1% indicate a probability of active rejection. This study assessed the relationship between dd-cfDNA and clinic events (Creatinine, DSA, Renal allograft IgAN and Albuminuria)

*Methods: Donor-derived cell-free DNA was assayed in 30 plasm samples with two reasons: high serum creatinine (13 samples) or DSA positive (17 samples). Dd-cfDNA quantification through Target Region Capture Sequencing and calculated by Maximum Likehood Estimation (MLE). Samples with detection value greater than 1% or suspicion of kidney injury were determined for graft biopsy.

*Results: The mean level of quantification of ddcfDNA in 30 plasm is 1.24% ± 1.4%. 17 patients have positive DSA, but only 8 patients (47%) dd-cfDNA higher than 1%, allograft biopsy performance in 15 patients confirmed all of 8 patients (higher dd-cfDNA) show pathologically rejection: 4 patients (1.3%, 1.68%, 1.9% and 2.52%) have chronic active humoral rejection, 3 patients (2.08%, 4.04% and 5.71%) belong to AMR. But none of allograft rejection evidence in remain 7 patients. The positive predictive value for DSA positive was 47%. 22 patients (73%) detected dd-cfDNA lower than 1%. Among them, 15 patients clinically performed pathological biopsy: 1 patient (0.67%) pathologically show chronic active rejection, 5 patients (0.33%, 0.54%, 0.54%, 0.69% and 0.76%) show allograft IgAN but 2 patients show DSA positive, The remain 9 patients (0.59% ± 0.1%) show toxicity of CNI or board line change. The positive predictive value for dd-cfDNA (level >1%) was 88%.

*Conclusions: Compared with DSA, dd-cfDNA can predict rejection more accurately. Detection of dd-cfDNA maybe service as a pre-biopsy necessity assessment in kidney transplant recipients

To cite this abstract in AMA style:

Cheng D, Li X, Jiang T, Liu H, Zhou Y, Shi H. Donor-derived Cell-free Dna In Donor Specific Antibody Positive Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-derived-cell-free-dna-in-donor-specific-antibody-positive-kidney-transplant-recipients/. Accessed May 9, 2025.

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