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논문분류	춘계학술대회 초록집
제목	Prospective study to evaluate the effectiveness of donor-derived cell-free dna for the prediction of biopsy proven rejection in renal transplant recipients
저자	Hyung Duk Kim
출판정보	2023; 2023(1):
키워드
초록	Objectives: In this study, we investigated to verify whether the titer of donor-derived cell-free DNA (dd-cfDNA) has diagnostic value in predicting biopsy-proven rejection in kidney transplant recipients (KTR). Methods: This study was prospectively designed to verify the effectiveness of dd-cfDNA for the diagnosis of biopsy-proven rejection in KTR. Analysis was performed on 42 KTR in Seoul St. Mary's Hospital. All these patients underwent an indication biopsy for reasons such as elevated serum creatinine, proteinuria, and DSA detection. Blood samples were collected immediately before the biopsy and dd-cfDNA test was performed using the AlloSeq cfDNA kit. The biopsy specimen was diagnosed by a renal pathologist according to Banff classification. Results: Of the total 42 patients, 19 patients were diagnosed with rejection. The median dd-cfDNA in all patients was 0.425%. Patients with dd-cfDNA values higher than the median value were assigned to the high dd-cfDNA group, and other patients were assigned to the low dd-cfDNA group. Incidence of total biopsy-proven rejection and antibody-mediated rejection were significantly higher in high dd-cfDNA group (p value 0.001 and 0.024, respectively). As a result of comparing the pathologic findings between two groups, the glomerulitis and peritubular capillaritis scores were higher in the high dd-cfDNA group. Logistic regression analysis revealed both DSA presence at the time of biopsy and high dd-cfDNA level were associated with biopsy-proven rejection (Adjusted odds 5.52 and 11.72, respectively). To evaluate the predictive value of dd-cfDNA for rejection, receiver operating characteristic (ROC) area under the curve (AUC) revealed 0.80; 95% confidence interval, 0.67 to 0.94 (p value 0.001). When using DSA and dd-cfDNA together, ROC AUC for rejection revealed 0.85; 95% confidence interval, 0.74 to 0.96 (p value<0.001). Conclusions: In KTR, the dd-cfDNA is useful marker for allograft rejection. In particular, the predictive power of renal injury related to glomerulitis and peritubular capillaritis was high.
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