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Donor-derived Cell-free DNA in Upper Extremity Vascular Composite Allograft Recipients

R. Kalsi1, M. Abuzeineh2, J. Littleton1, J. T. Shores1, D. S. Cooney1, C. Cooney1, R. J. Redett1, G. Brandacher1, D. C. Brennan2

1Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD, 2Nephrology, Johns Hopkins University, Baltimore, MD

Meeting: 2021 American Transplant Congress

Abstract number: 622

Keywords: Biopsy, Graft acceptance, Non-invasive diagnosis

Topic: Basic & Clinical Science » VCA

Session Information

Session Name: VCA

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Diagnosing rejection in VCA recipients relies on clinical exam and biopsy which are both easily confounded by common causes of skin irritation. dd-cfDNA in recipient plasma originating from injured or apoptotic donor allograft cells is a proven non-invasive indicator of allograft rejection in renal transplant recipients but has not been evaluated in VCA recipients.

*Methods: VCA patients presenting for evaluation at the outpatient plastic surgery clinic during periods of graft stability without clinical or histologic evidence of rejection, and/or during episodes of suspected clinical and/or biopsy proven rejection were included in this study. dd-cfDNA levels were collected prospectively at each visit with two commercially available kits. Based on established values in renal transplant, a dd-cfDNA level > 1% was considered suggestive of a rejection event.

*Results: 5 VCA recipients (3 bilateral and 1 unilateral upper limb, 1 lower abdominal wall, penis, and scrotum) were enrolled in this study. One patient had no clinical or biopsy evidence of rejection with dd-cfDNA level <1% and 1 patient had dd-cfDNA levels >4% at three time points surrounding an episode of biopsy proven BANFF CTA 2007 Grade III rejection. 1 patient with a stable graft and no clinical concern for rejection had a routine dd-cfDNA level >1%. A final patient with non-specific skin changes but biopsy evidence of severe acute cell mediated rejection had dd-cfDNA level <1%.

*Conclusions: These data reflect the first attempt to characterize dd-cfDNA in human upper extremity VCA recipients. Although these early results are conflicting, larger cohorts with careful correlation with biopsy findings are needed to fully characterize dd-cfDNA level trends in extremity VCA recipients.

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To cite this abstract in AMA style:

Kalsi R, Abuzeineh M, Littleton J, Shores JT, Cooney DS, Cooney C, Redett RJ, Brandacher G, Brennan DC. Donor-derived Cell-free DNA in Upper Extremity Vascular Composite Allograft Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-derived-cell-free-dna-in-upper-extremity-vascular-composite-allograft-recipients/. Accessed June 1, 2025.

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