Evolution of Donor-Derived Cell-Free DNA During the First Week After Surgery Predicts Renal Function Recovery After Kidney Transplantation

D. Cucchiari¹, E. Cuadrado¹, E. Gonzalez¹, J. Puig¹, M. Ramirez-Bajo¹, P. Ventura-Aguiar¹, I. Revuelta², B. Bayès¹, F. Diekmann¹

¹Hospital Clínic de Barcelona, Barcelona, Spain, ²Hospital Clinic de Barcelona, Barcelona, Spain

Meeting: 2022 American Transplant Congress

Abstract number: 276

Keywords: Ischemia, Kidney transplantation, Renal function, Renal ischemia

Topic: Basic Science » Basic Science » 14 - Ischemia Reperfusion

Session Information

Session Name: Ischemia Reperfusion

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 4:30pm-4:40pm

Location: Hynes Room 302

*Purpose: Donor-derived cell-free DNA (ddcfDNA) is usually employed starting from the second week after kidney transplantation (KT), as its earlier increase can be due to the ischemia-reperfusion injury (IRI) and would not reflect the presence of rejection. However, new data point out that ddcfDNA is not only a diagnostic biomarker of rejection but also has a prognostic value. We hypothesized that ddcfDNA released soon after IRI during the first week after surgery is associated with renal function recovery after KT.

*Methods: Fifty-two (52) recipients of a first kidney graft enrolled in the Prospective Assessment of Kidney Graft Events after Transplantation by Monitoring of ddcfDNA (PRAS-KAT) study were studied at 24 hours and 7 days after reperfusion by means of ddcfDNA assessed by the Alloseq (CareDx, Brisbane, CA, U.S.) kit. Results were studied in accordance with ddcfDNA relationship with Delayed-Graft Function (DGF) duration and 3- and 6-month eGFR calculated by CKD-EPI formula by means of Pearson Regression analysis.

*Results: Patients were recipients of a graft from a living (n=6), brain-death (n=22) or circulatory-death (n=24) donor. Median ischemia time was 13.20 [7.20-18.27] hours and induction was based on Basiliximab or Thymoglobuline in 30.8% and 68.2% of cases, respectively. DGF occurred in 16 patients (30.8%) with a median of 6 [1-13.75] days until last dialysis session. Median [IQR] values of ddcfDNA were 2.8 [1.7-5.2] % at 24 hours after reperfusion and 0.49 [0.24-0.67] % at 7 days. The percentage of ddcfDNA at 24 hours after reperfusion was associated with eGFR at 3 months (R=-0.303, P=0.051) and at 6 months (R=-0.434, P=0.021) after kidney transplantation. Also the percentage of ddcfDNA at 7 days was associated with eGFR at 6 months (R=-0.450, P=0.024). DGF duration in days was associated with ddcfDNA at 7 days (R=0.346, P=0.025).

*Conclusions: Evolution of ddcfDNA during the first week after surgery is associated with renal function recovery after transplantation, highlighting the value of this biomarker not only as a diagnostic marker but also as a prognostic one. In this sense, it could be a valid surrogate of the severity of the IRI and, consequently, may reflect the clinical recovery from DGF and long-term renal function.

To cite this abstract in AMA style:

Cucchiari D, Cuadrado E, Gonzalez E, Puig J, Ramirez-Bajo M, Ventura-Aguiar P, Revuelta I, Bayès B, Diekmann F. Evolution of Donor-Derived Cell-Free DNA During the First Week After Surgery Predicts Renal Function Recovery After Kidney Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/evolution-of-donor-derived-cell-free-dna-during-the-first-week-after-surgery-predicts-renal-function-recovery-after-kidney-transplantation/. Accessed May 18, 2025.

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