Abstract: FR-PO0747
Role of Gene Expression Profiling (TruGraf) and Donor-Derived Cell-Free DNA (TRAC) in Detecting Rejection and Monitoring Treatment Response in Pediatric Kidney Transplant Recipients
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Kizilbash, Sarah J., University of Minnesota, Minneapolis, Minnesota, United States
- Sebastian, Anjalin, University of Minnesota, Minneapolis, Minnesota, United States
- Jensen, Chelsey Joy, University of Minnesota, Minneapolis, Minnesota, United States
- Agboli, Isioma, Eurofins Transplant Genomics, LLC, Lenexa, Kansas, United States
- Movileanu, Iulia, Eurofins Transplant Genomics, LLC, Lenexa, Kansas, United States
- Evans, Michael David, University of Minnesota, Minneapolis, Minnesota, United States
Background
Timely treatment of allograft rejection is crucial in preventing premature graft loss. This pilot study aimed to evaluate the effectiveness of blood gene expression profiling (GEP) and donor-derived cell-free DNA (cfDNA) in detecting rejection and monitoring response to treatment through serial measurements in pediatric kidney transplant recipients.
Methods
We prospectively recruited 24 pediatric kidney transplant recipients (aged <21 years) who underwent a for-cause biopsy between 8/20/23 and 2/6/25. Blood samples for GEP and cfDNA were collected at the time of the biopsy (week 0) and at weeks 4 and 8. Serial creatinine levels were also measured. GEP results are presented as TX (transplant excellence) and non-TX. cfDNA results are presented as percentages.
Results
Median age of participants was 6.2 years (IQR: 3.9, 13.7); 50% were male, and 92% were white. Combining GEP results from weeks 0 and 4 (at least one non-TX) yielded sensitivity of 100% (9/9), specificity of 64% (7/11), positive predictive value (PPV) of 69% (9/13), and negative predictive value (NPV) of 100% (7/7) for rejection detection (p = 0.005). The combination of non-TX GEP results and cfDNA >1% at week 0 yielded sensitivity of 33% (3/9), specificity of 100% (13/13), PPV of 100% (3/3), and NPV of 68% (13/19) (p = 0.05). Figures 1 and 2 illustrate serial creatinine, cfDNA, and GEP results. Unlike creatinine, notable improvements were observed in GEP and cfDNA after treatment.
Conclusion
Serial measurements of GEP may improve the sensitivity, and combining GEP with cfDNA may improve the specificity of rejection biomarkers. Serial measurements of GEP and cfDNA may be helpful in determining treatment response.
Funding
- Commercial Support – Eurofin Transplant Genomics