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Kidney Week

Abstract: PO2185

Impact of Low-Normal vs. High-Normal Baseline Donor-Derived Cell-Free DNA Levels on Two-Year Allograft Function Following Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Grazier, Angela, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Chopra, Bhavna, Allegheny Health Network, Pittsburgh, Pennsylvania, United States

Group or Team Name

  • AHN Nephrology

Donor derived cell free DNA (dd-cfDNA) is a biomarker that helps to predict acute rejection in kidney allografts. Baseline dd-cfDNA levels are <1% in 96% of kidney transplant recipients (KTRs) and a value ≥ 1% suggests allograft injury usually from acute rejection. dd-cfDNA levels <1% are considered as normal. We tested whether low-normal vs. high-normal baseline dd-cfDNA values would have differing impact on longitudinal allograft function.


We identified patients who underwent kidney transplantation at our center between September 2017 and June 2020 and had dd-cfDNA (AlloSure, CareDx, Brisbane, CA) levels under the surveillance protocol at or around 8 weeks post-transplantation. Those KTRs with dd-cfDNA levels <1.0% were included in the analysis. Patients were divided into 2 groups based on the dd-cfDNA levels : group 1 with dd-cfDNA <0.5% (low-normal) and group 2 with dd-cfDNA 0.5-0.99% (high-normal). Estimated glomerular filtration rates (eGFR) between the groups at 3 month intervals were compared using box plots and longitudinal eGFR up to 2 years post-transplant were compared between the groups using lineal mixed model.


There were 111 patients included in the analysis including 62 males and 49 females. Among the study group, 39 had living and 72 received deceased donor kidneys. There were 96 patients in group 1, and 15 patients in group 2. We observed no differences either in 3-month interval cross-sectional eGFRs (fig 1A) or 2 -year longitudinal eGFRs (fig 1B) between the groups.


Our analysis found no differences between early post-transplant low-normal and high-normal baseline dd-cfDNA levels in terms of the impact on eGFR up to 2 post-transplant years in KTRs. These findings support the use of 1% cut off as a threshold to separate normal from abnormal dd-cfDNA levels.


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