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Single Center Experience in Using Donor-Derived Cell-Free DNA in Kidney Transplant

P. Homkrailas1, S. Lee2, B. Kandagedon1, G. Danovitch1, S. Bunnapradist1

1Medicine, Division of Nephrology, Kidney and Pancreas Transplant Programs, UCLA, Los Angeles, CA, 2Department of Pharmacy, UCLA, Los Angeles, CA

Meeting: 2020 American Transplant Congress

Abstract number: A-302

Keywords: Kidney transplantation, Non-invasive diagnosis, Rejection

Session Information

Session Name: Poster Session A: Biomarkers, Immune Assessment and Clinical Outcomes

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: While the gold standard for diagnosing allograft rejection in kidney transplant recipients (KTX) continues to be histopathologic evaluation, it has been well recognized that a kidney biopsy is not without risks for complications such as bleeding. The introduction of a Medicare approved donor-derived cell-free DNA (dd-cfDNA) testing has potentially allowed for a non-invasive method for detecting allograft injury. As it requires only patient serum, dd-cfDNA may be safer and can be performed more frequently than a kidney biopsy. We herein describe our experience in utilizing commercial available dd-cfDNA to help determine patients with vs. without rejection.

*Methods: We included all KTX who had dd-cfDNA testing at our institution between 3/2018-10/2019. Patients were stratified into for cause vs. surveillance dd-cfDNA. Correlation between dd-cfDNA level and allograft rejection was assessed. Acute rejection were all defined by kidney biopsy. Per manufacturer, dd-cfDNA level > 1% is considered active rejection and result < 1% is considered no active rejection. KTX with dd-cfDNA but without concurrent kidney biopsy nor rejection treatment were presumed to be without allograft rejection.

*Results: A total of 139 dd-cfDNA results from 95 KTX were included, of which 77 dd-cfDNA were for cause vs. 62 dd-cfDNA were surveillance. In the 77 for cause dd-cfDNA, there were 16 biopsy proven rejections but only 6 had positive dd-cfDNA. In the 62 surveillance dd-cfDNA, there were 7 biopsy proven rejections but only 3 had positive dd-cfDNA. Positive and negative predictive values for rejection in for cause KTX were 53.3% and 85.4%, respectively. In surveillance, positive and negative predictive values for rejection were 56.7% and 93.8%, respectively. Median dd-cfDNA level was 0.65% in rejection group and 0.29% in no rejection group.

*Conclusions: Donor-derived cell-free DNA level < 1% may be used to exclude rejection in KTX with stable allograft function. However, among those with dd-cfDNA > 1%, a kidney biopsy will still be needed to confirm rejection diagnosis as a positive predictive value was only 53.3-56.7%.

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To cite this abstract in AMA style:

Homkrailas P, Lee S, Kandagedon B, Danovitch G, Bunnapradist S. Single Center Experience in Using Donor-Derived Cell-Free DNA in Kidney Transplant [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/single-center-experience-in-using-donor-derived-cell-free-dna-in-kidney-transplant/. Accessed May 11, 2025.

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