Abstract: PUB032
Continuous Routine Detection of Donor-Derived Cell-Free DNAGuides the Diagnosis and Treatment of Subclinical Rejection
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Cheng, Dongrui, Nanjing General Hospital of Nanjing Military Command Research Institute of Nephrology, Nanjing, Jiangsu, China
- Cuello Garcia, Haider, Jiangsu University, Zhenjiang, Jiangsu, China
- Jiang, Tingya, AlloDx Biotech, Shanghai, Shanghai, China
Introduction
Donor-derived cell-free DNA (ddcfDNA) has been closely associated with antibody-mediated rejection (ABMR), however, there are few reports on using ddcfDNA to diagnose and treament evaluation for subclinical ABMR (subABMR). This study imployed a serial ddcfDNA testing in one KTx with subABMR.
Case Description
A 64-year-old man experience subclinical ABMR (subABMR) with devolpment DSA (A11, MFI=1530), and increase ddcfDNA (5.1%) after 4 years of transplantation. The result of biopsy shows 40% of peritubular capillaries with C4d positivity (Fig 1A, 1-4). The patient was treated with a combination of 200 mg of Rituximab and Intravenous Immunoglobulin. During follow-up, ddcfDNA levels were assessed in the first month post-treatment and subsequently every 6 months. DdcfDNA levels were decreased over time, at 24 months post-treatment, the ddcfDNA % value decreased to 1.03%. At this point, a repeat biopsy of the transplanted kidney revealed decrease pathological features of rejection with resolution of tubulitis. C4d staining changed from being positive in 40% ptc to negative; however, Glomerulonephritis (g=1) and ptc (>10%) remained positive (Fig. 1A, 2-2, 2-3, 2-4). Following a total surveillance duration of 28 months, it was found that the value increased by 48.5% during the fifth examination of the ddcfDNA. And considering the second biopsy showed ABMR, we promptly administered 200 mg of RIX, resulting in a subsequent decrease in ddcfDNA values. The patient has been followed up for nearly 5 years since then, with stable ddcfDNA levels and negative antibody status (Fig. 1B).
Discussion
This study highlights the utility of ddcfDNA as a biomarker for detecting subABMR. Monitoring ddcfDNA levels allowed for precise evaluation of treatment response and adjustment of therapy dosage. The study suggests that ddcfDNA may be is a reliable biomarker for subABMR.