Incorporation of Donor-derived Cell-free DNA Into Clinical Practice for Renal Allograft Management

被引：5

作者：

Qazi, Yasir ^{[1
]}

Patel, Anup ^{[2
]}

Fajardo, Mark ^{[3
]}

McCormick, Sarah ^{[3
]}

Fehringer, Gordon ^{[3
]}

Ahmed, Ebad ^{[3
]}

Malhotra, Meenakshi ^{[3
]}

Demko, Zachary P. ^{[3
]}

Billings, Paul R. ^{[3
]}

Tabriziani, Hossein ^{[3
]}

Gauthier, Philippe ^{[3
]}

机构：

[1] Univ Southern Calif, Dept Med, Los Angeles, CA 90007 USA

[2] St Barnabas Hosp, Livingston, NJ USA

[3] Natera Inc, San Carlos, CA USA

来源：

TRANSPLANTATION PROCEEDINGS | 2021年 / 53卷 / 10期

关键词：

REJECTION; OUTCOMES;

D O I：

10.1016/j.transproceed.2021.09.027

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Donor-derived cell-free DNA (dd-cfDNA) in plasma is an established noninvasive biomarker for allograft injury and rejection. A single-nucleotide polymorphism (SNP)-based massively multiplexed polymerase chain reaction methodology can be used to quantify dd-cfDNA in kidney transplant recipients. In this study we describe our clinical experience in using a SNP-based dd-cfDNA assay for the management of active rejection in renal transplant recipients. Methods. To assess the clinical utility of a clinically available SNP-based massively multiplexed polymerase chain reaction dd-cfDNA assay, we analyzed biopsy data contemporaneous to dd-cfDNA results at 33 participating clinics and calculated the rate of rejection in dd-cfDNA-matched biopsy results. Results. A total of 1347 dd-cfDNA test samples from 879 patients were accessioned from October 3, 2019, to November 2, 2020. The dd-cfDNA testing classified 25.2% (340/1347) of samples as high-risk (dd-cfDNA fraction >= 1%). Clinical follow-up was available for 32.1% (109/340) of the high-risk results, which included samples from 28 patients with definitive biopsy results within 2 weeks of dd-cfDNA testing. Pathology reports indicated a 64% (18/28) rate of active rejection in biopsy result-matched samples. Total cfDNA measurements indicated a skewed distribution and a correlation with dd-cfDNA-derived patient risk classification. Conclusions. This is the first report showing the impact of dd-cfDNA on patient management in a multicenter real-world clinical cohort. The data indicate that incorporating dd-cfDNA testing into practice may improve physician decision making regarding renal allograft recipients.

引用

页码：2866 / 2872

页数：7

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