Donor-derived cell-free DNA predicted allograft rejection and severe microvascular inflammation in kidney transplant recipients

被引：6

作者：

Kim, Hyung Duk ^{[1
]}

Bae, Hyunjoo ^{[2
]}

Kang, Hyunhye ^{[3
,4
]}

Lee, Hanbi ^{[5
]}

Eum, Sang Hun ^{[6
]}

Yang, Chul Woo ^{[5
]}

Choi, Yeong Jin ^{[7
]}

Chung, Byung Ha ^{[5
]}

Oh, Eun-Jee ^{[3
,4
]}

机构：

[1] Catholic Univ Korea, Eunpyeoung St Marys Hosp, Coll Med, Dept Internal Med,Div Nephrol, Seoul, South Korea

[2] Catholic Univ Korea, Dept Biomed & Hlth Sci, Seoul, South Korea

[3] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Lab Med, Seoul, South Korea

[4] Catholic Univ Korea, Res & Dev Inst Vitro Diagnost Med Devices, Seoul, South Korea

[5] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Internal Med,Div Nephrol, Seoul, South Korea

[6] Catholic Univ Korea, Incheon St Marys Hosp, Coll Med, Dept Internal Med,Div Nephrol, Seoul, South Korea

[7] Catholic Univ Korea, Dept Hosp Pathol, Seoul St Marys Hosp, Coll Med, Seoul, South Korea

来源：

FRONTIERS IN IMMUNOLOGY | 2024年 / 15卷

基金：

新加坡国家研究基金会;

关键词：

kidney transplantation; cell-free nucleic acids; allograft rejection; microvascular rejection; tissue donors; ANTIBODY-MEDIATED REJECTION;

D O I：

10.3389/fimmu.2024.1433918

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Introduction: The aim of this study is to investigate the clinical validity of donor-derived cell-free DNA (dd-cfDNA) in comparison with that of donor specific anti-HLA antibody (DSA) for predicting biopsy-proven rejection (BPR)and severe microvascular inflammation (severe MVI) in kidney transplant recipients (KTRs). Methods: In this prospective observational investigation, 64 KTRs who underwent the indicated biopsies were included. Blood samples collected prior to biopsy were tested for dd-cfDNA and DSA. Biopsy specimens were classified by a renal pathologist according to the Banff classification. The predictive performance of dd-cfDNA and DSA for histological allograft diagnosis was assessed. Results: KTRs were categorized into the high and low dd-cfDNA groups based on a level of 0.4%. Eighteen patients (28.1%) had positive DSA at biopsy, exhibiting higher dd-cfDNA levels than the DSA-negative patients. BPR and severe MVI incidences were elevated in the high dd-cfDNA group (BPR: 42.9% vs. 3.4%, P <0.001; severe MVI: 37.1% vs. 3.4%, P = 0.001). Also, elevated glomerulitis and MVI scores were observed in the high dd-cfDNA group. DSA showed the highest predictive value for BPR (AUC = 0.880), whereas dd-cfDNA alone excelled in predicting severe MVI (AUC = 0.855). Combination of DSA and dd-cfDNA (>0.4%) yielded sensitivities of 80.0% and 50.0% with specificities of 90.7% and 88.0% for antibody-mediated rejection and severe MVI detection, respectively. Conclusion: The dd-cfDNA test is a predictive tool for BPR and severe MVI, and it can improve the performance, especially when combined with DSA for BPR.

引用

页数：10

共 35 条

[21] Diagnostic value of donor-derived cell-free DNA to predict antibody-mediated rejection in donor-specific antibody-positive renal allograft recipients [J].