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Kidney Week

Abstract: SA-PO687

Utility of Donor-Derived Cell-Free DNA in Pediatric Kidney Transplantation: Initial Results from the NAPRTCS Registry Centers

Session Information

  • Pediatric Nephrology - 2
    October 26, 2024 | Location: Exhibit Hall, Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Dharnidharka, Vikas R., Washington University in St Louis, St Louis, Missouri, United States
  • Boynton, Sara Ashley, Johns Hopkins University, Baltimore, Maryland, United States

Group or Team Name

  • NAPRTCS Investigators.
Background

Peripheral blood donor-derived cellfree DNA (dd-cfDNA) percentage is a novel biomarker for acute rejection (AR) in adults, but studies in a large cohort of children are lacking. The North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS), a voluntary multi-center consortium that has been collecting data on children with kidney transplants (pKT) since 1987, expanded the registry with a CareDx grant in 2022 to collect dd-cfDNA data.

Methods

In addition to pKT data routinely collected by NAPRTCS, dd-cfDNA percentage results obtained as part of standard care were collected. Centers provided the assay type used (Allosure; Prospera or other) and whether the test was associated with a biopsy or an episode of AR.

Results

To date, we have 1386 dd-cfDNA results, from 305 unique recipients (median 3 results per patient, IQR 2, 6), from test dates 10/8/18 to 2/2/24, representing pKT dates 10/8/08 to 4/2/24, from 14 different centers, median 16 patients and 58 results per center. Recipient demographics mirrored the overall population. The dd-cfDNA test used was Allosure in 1294 (93.3%; median result 0.34%, range 0.04-16.0) and Prospera in 92 (6.7%; median 0.83, range 0.04-18.44). On the forms, test results were associated with a biopsy for 706 Allosure (median dd-cfDNA 1.1%; range 0.07-16, Fig 1 panel A) and 64 Prospera results (median 2.9%; range 0.1-9.46, panel B) and to AR in 122 Allosure (median 1.4%, range 0.07 -13, panel C) and 11 Prospera results (median 4.2%, range 0.1-9.46, panel D).

Conclusion

In this large pediatric cohort study, higher dd-cfDNA levels associated with pKT biopsy or an AR event. Further analyses will calculate AR test efficacy via ROC curves, separated by surveillance or for-cause detailed biopsy results.

Funding

  • Commercial Support – CareDx grant to NAPRTCS