Donor-derived cell-free DNA predicted allograft rejection and severe microvascular inflammation in kidney transplant recipients.
Front Immunol
; 15: 1433918, 2024.
Article
in En
| MEDLINE
| ID: mdl-39044817
ABSTRACT
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Tissue Donors
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Kidney Transplantation
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Cell-Free Nucleic Acids
/
Graft Rejection
Limits:
Adult
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Female
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Humans
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Male
/
Middle aged
Language:
En
Journal:
Front Immunol
/
Front. immunol
/
Frontiers in immunology
Year:
2024
Document type:
Article
Country of publication: