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Abstract: PO2197

Can Donor-Derived Cell-Free DNA or Gene Expression Profile Be Used to Monitor Response to Treatment After Subclinical Acute Rejection?

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Park, Sookhyeon, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Dietch, Zachary, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Guo, Kexin, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Zhao, Lihui, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Friedewald, John J., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
Background

Subclinical acute rejection (subAR) is defined as acute rejection with stable kidney allograft function. Creatinine is not sensitive enough to detect subAR. Donor-derived cell-free DNA (dd-cfDNA) and gene expression profile (GEP) have been used for acute rejection detection in kidney allograft. We hypothesized that dd-cfDNA and GEP could be used to monitor response to treatment of rejection after subAR.

Methods

We analyzed dd-cfDNA and GEP results from 14 unique subjects in the CTOT08 study with subAR who had 8 weeks follow-up biopsy after treatment. Blood samples were paired with kidney biopsies, and collected after subAR during the intensive monitoring periods. We calculated the mean and standard deviation (SD) for each group at the same time points. A paired T-test was used to generate p-values. We conducted locally estimated scatterplot smoothing (LOESS) and linear mixed effect models for the analysis of serial changes of dd-cfDNA scores.

Results

Of 14 patients, subAR resolved in 5 patients (36%) but 9 (64%) patients had persistent rejection after treatment. The slope of dd-cfDNA scores was not significantly different between the resolved and the unresolved group (p-value = 0.43) (Figure 1A). The slope of GEP scores in the resolved group tended to be steeper than unresolved group one after treatment but was not statistically significant between the two slopes (p-value = 0.06)(Figure 1B).

Conclusion

GEP scores showed a greater decrease after successful treatment compared to dd-cfDNA scores. Repeating GEP after subAR might be useful to monitor treatment of rejection.

Funding

  • Commercial Support