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Kidney Week

Abstract: PO2421

Microvascular Inflammation Is the Main Determinant of Elevated Donor-Derived Cell-Free DNA in Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Obrisca, Bogdan, Fundeni Clinical Institute, Bucharest, Romania
  • Butiu, Maria, University of Washington, Seattle, Washington, United States
  • Bakthavatsalam, Ramasamy, University of Washington, Seattle, Washington, United States
  • Smith, Kelly D., University of Washington, Seattle, Washington, United States
  • De Castro, Iris C., University of Washington, Seattle, Washington, United States
  • Blosser, Christopher D., University of Washington, Seattle, Washington, United States
  • Sibulesky, Lena, University of Washington, Seattle, Washington, United States
  • Kling, Catherine, University of Washington, Seattle, Washington, United States
  • Ismail, Gener, Fundeni Clinical Institute, Bucharest, Romania
  • Sorohan, Bogdan Marian, Fundeni Clinical Institute, Bucharest, Romania
  • Leca, Nicolae, University of Washington, Seattle, Washington, United States
Background

Microvascular inflammation (Mi) is the main histological lesion for ABMR. Mi may occur separate from other ABMR criteria, early in the injury process, and may not be captured by the current Banff criteria. Donor-derived cell-free DNA (dd-cfDNA) has the potential to identify early allograft injury and supplement the current diagnostic criteria for rejection.

Methods

We included all patients(n=54) who underwent a kidney transplant biopsy for suspicion of rejection at our center from 9/17-12/19. Determinants of a biopsy were renal dysfunction, elevated dd-cfDNA, or presence of DSAs.

Results

Dd-cfDNA correlated strongly with the presence of ABMR, Class II DSA>2500, and histological lesions of ABMR. The strongest association was with Mi lesions (OR 192,95%CI: 18.6, 1984, p<0.001). Of the 18 patients with Mi, 2 did not meet the criteria for ABMR and had a dd-cfDNA level of 0.32% and 1.9%. All patients with Mi that met the criteria for ABMR had a dd-cfDNA over 1%. There was no association with renal function or histological lesions of tubulitis or interstitial inflammation (Fig 2).

Conclusion

Dd-cfDNA has the potential to identify early allograft injury and allow for early and less aggressive interventions that can beneficially alter long term outcomes of kidney transplant recipients.

The absolute level of dd-cfDNA and its correlation with rejection type and microvascular inflammation

Binary logistic regression analysis regarding variables associated with a high dd-cfDNA level (>1%)

Funding

  • Commercial Support