Abstract: FR-PO1199
Donor-Derived Cell-Free DNA in Kidney Transplant Recipients with Recurrent Lupus Nephritis
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Campana, Otto, Hospital General Macas, Macas, Morona Santiago, Ecuador
- Acevedo Rodriguez, Jessica Edith, John H Stroger Jr Hospital of Cook County, Chicago, Illinois, United States
- Rodriguez Reyes, Leonardo, The University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, United States
- Pozo Garcia, Leonardo, Arizona Kidney Disease and Hypertension Center, Tucson, Arizona, United States
Introduction
Donor-derived cell-free DNA (dd-cfDNA) is a well-established biomarker for diagnosis and monitoring of rejection in kidney transplant recipients. However, data on its role in recurrent lupus nephritis (LN) is not well established.
Case Description
Case 1: A 30-year-old gentleman with end-stage renal disease (ESRD) due to LN underwent a living-related kidney transplant (LRRT) in 2023. One year later, surveillance testing was remarkable for an elevated dd-cfDNA. For cause allograft biopsy demonstrated class III lupus nephritis. Belimumab was started. After 1 year of treatment, dd-cfDNA normalized.
Case 2: A 39-year-old woman with ESRD due to LN received an LRRT in 2009. Her course was complicated with recurrent LN in 2024 due to non-adherence. Initial re-evaluation showed a low C3 and C4, elevated anti-dsDNA, proteinuria, and loss of kidney function. The dd-cfDNA was normal. For cause allograft biopsy demonstrated class V LN. Therapy was offered, but the patient remained non-adherent.
Case 3: A 44-year-old gentleman with ESRD due to LN received a pediatric en bloc kidney transplant in 2023. Two years later, he underwent evaluation due to proteinuria. He had an elevated anti-dsDNA, and his fraction of dd-cfDNA was elevated. For cause allograft biopsy showed class IV LN. After treatment with intravenous steroids and belimumab, lupus markers and dd-cfDNA became negative.
Discussion
The utility of dd-cfDNA varies according to LN class. No significant changes were observed in class V LN, which may reflect its more chronic, insidious course and type of injury compared to the acute and inflammatory nature of classes III and IV. Notably, in case 1, the elevation of dd-cfDNA preceded changes in the conventional LN biomarkers, supporting its potential role in early disease stages. More studies are needed to support these findings.