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Elevation of Donor-derived Cell-free DNA Before Biopsy-proven Rejection in Kidney Transplant

Elevation of Donor-derived Cell-free DNA Before Biopsy-proven Rejection in Kidney Transplant

September 2024 | Jonathan S. Bromberg, MD, PhD, Suphamai Bunnapradist, MD, MS, Milagros Samaniego-Picota, MD, Sanjiv Anand, MD, Erik Stites, MD, Philippe Gauthier, MD, MBA, Zachary Demko, PhD, Adam Prewett, MBA, Madeleine Armer-Cabral, MS, Kyle Marshall, MS, Navchetan Kaur, PhD, Michelle S. Bloom, PhD, Hossein Tabriziani, MD, Sangeeta Bhorade, MD, and Matthew Cooper, MD, on behalf of the ProActive Investigators
The study by Bromberg et al. evaluates the utility of donor-derived cell-free DNA (dd-cfDNA) as an early indicator of biopsy-proven rejection in kidney transplant recipients. The ProActive registry, a multicenter, observational study, assessed dd-cfDNA and serum creatinine levels before biopsies in 424 patients. The results showed that dd-cfDNA levels were significantly elevated 5 months before antibody-mediated rejection (ABMR) and 2 months before T cell-mediated rejection (TCMR) compared to nonrejection biopsies. In contrast, serum creatinine levels did not show significant differences between rejection and nonrejection groups. Additionally, among patients with nonrejection biopsies, those with multiple increased dd-cfDNA results had lower estimated glomerular filtration rates (eGFR) and were more likely to have high immune risk factors. The study suggests that elevated dd-cfDNA can help identify patients at high risk of ongoing or future rejection, potentially allowing for earlier intervention and improved outcomes.The study by Bromberg et al. evaluates the utility of donor-derived cell-free DNA (dd-cfDNA) as an early indicator of biopsy-proven rejection in kidney transplant recipients. The ProActive registry, a multicenter, observational study, assessed dd-cfDNA and serum creatinine levels before biopsies in 424 patients. The results showed that dd-cfDNA levels were significantly elevated 5 months before antibody-mediated rejection (ABMR) and 2 months before T cell-mediated rejection (TCMR) compared to nonrejection biopsies. In contrast, serum creatinine levels did not show significant differences between rejection and nonrejection groups. Additionally, among patients with nonrejection biopsies, those with multiple increased dd-cfDNA results had lower estimated glomerular filtration rates (eGFR) and were more likely to have high immune risk factors. The study suggests that elevated dd-cfDNA can help identify patients at high risk of ongoing or future rejection, potentially allowing for earlier intervention and improved outcomes.
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Understanding Elevation of Donor-derived Cell-free DNA Before Biopsy-proven Rejection in Kidney Transplant