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Kidney Week

Abstract: PO2401

Protocol-Based Donor-Derived Cell-Free DNA Surveillance in Kidney Transplant Recipients: A Single-Center Experience

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Nissaisorakarn, Pitchaphon, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Patel, Het, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Pavlakis, Martha, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Aala, Amtul, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Agrawal, Nikhil, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background

Kidney biopsy is invasive and has limited utility when used as a surveillance test post-transplant. Donor-derived cell-free DNA (dd-cfDNA) surveillance testing has never been studied in comparison with other routinely performed surveillance tests.

Methods


Our transplant center implemented the dd-cfDNA (Allosure ®) surveillance protocol (1,2,3,4,6 months and then quarterly post-op) in kidney transplant recipients starting July 2018, in addition to our existing protocol measurements of serum Cr, proteinuria and DSA.

We retrospectively reviewed all kidney alone transplant recipients transplanted between July 2018- April 2020. Data collection was done at time of dd-cfDNA surveillance and included: dd-cfDNA (positive if >1% dd-cfDNA), elevated Cr (≥0.3mg /dL from Baseline), elevated proteinuria (≥0.3 mg/dL from baseline), DSA (if available).

Results

366 screening dd-cfDNA test results were reviewed from 84 patients. There were 13/366 positive dd-cfDNA tests in 8/84 patients.
5 of the 8 patients underwent a kidney biopsy which showed: 4 rejections (2 humoral, 2 cellular) (for 1 patient who had cellular rejection, dd-cfDNA test was the only surveillance test that was positive) and 1 ATN (dd-cfDNA test was borderline positive at 1.0%). The remaining 3 patients did not undergo a biopsy and repeat dd-cfDNA testing improved without intervention.

In the 353/366 negative dd-cfDNA tests in 76 patients: 8 patients underwent a biopsy: 2 patients who had increased Cr showed borderline acute cellular rejection, 3 had recurrent disease (MPGN, DM, IgAN) and 3 showed ATN/Vascular disease/IFTA. In the 2 patients with borderline acute cellular rejection dd-cfDNA was <0.7%.

Conclusion

We found that the addition of surveillance dd-cfDNA testing to current testing algorithm was able to identify rejection in 1 patient, when others surveillance tests were negative. A negative result may obviate the need for biopsy, including protocol biopsies in centers who perform them.

 No biopsy performedBiopsy Performed
RejectionNo rejection
dd-cfDNA positive841
dd-cfDNA negative3432 (borderline ACR)8
Total35115
 
Standard protocol positive3356
Standard protocol negative31813
Total35115

Funding

  • Commercial Support