Abstract: SA-PO1051
Noninvasive Monitoring for Rejection: Need of the Hour, an In-Center Experience with Donor-Derived Cell-Free DNA (dd-cf-DNA) and Its Association with Antibody-Mediated Rejection (ABMR)
Session Information
- Transplantation: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Khan, Umair, University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Warraich, Fatima Z., University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Greco, Barbara A., University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Germain, Michael J., University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
Background
Conventional modalities for detecting allograft rejection predominantly revolve around serial measurements of serum creatinine, and proteinuria. Serum creatinine, is a poor marker for detection of rejection as it lags considerably, and histologic analysis can be non-specific and operator dependent. Allograf biopsy remains the gold standard for detecting allograft rejection however biopsy is an expensive and invasive procedure by itself with risk of multiple complications. The quest for non-invasive tests for early rejection has been elusive.
Recent advancements have shifted this paradigm towards newer diagnostic tests that independently provide an estimate into the injury state of the allograft kidney. Of these newer diagnostic modalities, dd-cf-DNA and gene expression, can be done regularly and can be used to complement traditional histological analysis.
Methods
We undertook a retrospective observational study in our renal transplant recipients to assess an association of dd-cf-DNA, gene expression, molecular tissue markers and histological analysis. We looked at the correlation of these variable with presence of antibody mediated rejection (ABMR) that was validated via protocol biopsy and molecular tissue marker analysis.
Results
We observed that dd-cf-DNA > 0.58% correlated with histological and molecular tissue marker proven antibody mediated rejection (ABMR). Furthermore, cf-DNA did not correlate with TCMR nor gene expression had any association with ABMR. With this study we report that a dd-cf-DNA of more than 0.58% is suggestive of ABMR which in the future can be used as a sole noninvasive test to diagnose ABMR and thereby avoiding the need for protocol biopsy.
Conclusion
Noninvasive monitoring for rejection is a need of the hour. Available literature along with our study supports the notion that cf-DNA is valuable in detecting ABMR.
Correlation of dd-cf-DNA with ABMR.