Session Name: Kidney Acute Antibody Mediated Rejection
Session Date & Time: None. Available on demand.
*Purpose: Delayed graft function (DGF) may reduce long-term kidney allograft survival due to ischemia-reperfusion injury and rejection. Donor Derived Cell-Free DNA (dd-cfDNA) is proposed to be a non-invasive marker for detection of allograft rejection and injury. Dd-cfDNA are higher in deceased than living donor recipients in the first week after Kidney Transplant (KTxp) and decrease to less than 1.0% in the absence of DGF. This exploratory study describes the kinetics of dd-cfDNA in the immediate post-transplant period in patients with DGF, which has not been studied previously, and determines its’ correlation with allograft function.
*Methods: Eight deceased-donor KTxp recipients at high risk for DGF (score of 30% or more on Irish Nomogram: Irish W et al. AJT,10:2279-2286) were enrolled after signing an informed consent. Blood samples were collected daily for 7 days post-KTxp for dd-cfDNA (AlloSure, CareDx).
*Results: Table 1 shows baseline recipient and donor characteristics. All patients had DGF with subsequent recovery of allograft function. Median duration of DGF was 9.5 days (IQR 6.5-21.8). Median nadir serum creatinine (sCr) was 1.4 mg/dL (IQR 0.98-1.8) at last follow up of 1-7 (median 2.5) months post KTxp. The dd-cfDNA kinetics for each patient is shown in Figure 1. Median dd-cfDNA level at day 1 was 14% (IQR 3-17%) and at day 7 was 0.45% (IQR 0.3-1.36%). Duration of DGF showed weak correlation with daily average decline in dd-cfDNA (R2=0.37), but no correlation with dd-cfDNA level at day 7 (R2=0.0005). There was no correlation of nadir sCr with daily average decline in dd-cfDNA (R2=0.03) or dd-cfDNA level at day 7 (R2=0.001).
|Recipient characteristics||Donor characteristics|
|Median age||59.5 years (IQR 44-62.8)||51 years (IQR 28-58.5)|
|Race||4 Black, 2 Asian, 2 White||1 Black, 7 White|
|Sex||3 Female, 5 Male||3 Female, 5 Male|
|Median time on dialysis||48.5 months (IQR 29.8-71.5)|
|Median KDPI||67.5% (IQR 40.5-89)|
*Conclusions: In patients with DGF who received kidneys from DCD donors, dd-cfDNA levels are elevated immediately after KTxp, but decline within the first week to <1.5%. Our data suggests that in these patients, elevated dd-cfDNA of >1.5% (3x the median) and not decreasing 7 days after KTxp warrants further investigation for the cause of persistent elevation which may include rejection, obstruction, recurrent disease etc.
To cite this abstract in AMA style:Gumber R, Abuzeineh M, Mejia C, Brennan D, Naqvi F. Donor Derived Cell-free DNA Kinetics Early After Kidney Transplant in Patients with Delayed Graft Function Who Received Kidneys from Donation After Cardiac Death Donors [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-derived-cell-free-dna-kinetics-early-after-kidney-transplant-in-patients-with-delayed-graft-function-who-received-kidneys-from-donation-after-cardiac-death-donors/. Accessed June 11, 2021.
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