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Prognostic value of the donor‐derived cell‐free DNA assay in acute renal rejection therapy: A prospective cohort study
Author(s) -
Shen Jia,
Guo Luying,
Yan Pengpeng,
Zhou Jingyi,
Zhou Qin,
Lei Wenhua,
Liu Haitao,
Liu Guangjun,
Lv Junhao,
Liu Feng,
Huang Hongfeng,
Dong Wenzhao,
Shu Liping,
Wang Huiping,
Wu Jianyong,
Chen Jianghua,
Wang Rending
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14053
Subject(s) - medicine , cell free fetal dna , methylprednisolone , renal function , urology , prospective cohort study , transplantation , kidney transplantation , biomarker , gastroenterology , oncology , pregnancy , fetus , biochemistry , genetics , chemistry , prenatal diagnosis , biology
Donor‐derived cell‐free DNA (dd‐cfDNA) is a promising biomarker for monitoring allograft status. However, whether dd‐cfDNA can reflect real‐time anti‐rejection treatment effects remains unclear. We prospectively recruited 28 patients with acute renal rejection, including 5 with ABMR, 12 with type IA or type IB rejection, and 11 with type IIA or IIB rejection. dd‐cfDNA levels in peripheral blood were measured using human single nucleotide polymorphism (SNP) locus capture hybridization. The percentage of dd‐cfDNA (dd‐cfDNA%) declined significantly from 2.566 ± 0.549% to 0.773 ± 0.116% ( P < .001) after anti‐rejection therapy. The dd‐cfDNA% decreased steadily over the course of 3 days with daily methylprednisolone injections, but no significant difference in the dd‐cfDNA% was observed between the end of anti‐rejection therapy and 2 weeks later. Changes in the dd‐cfDNA% (∆dd‐cfDNA%) demonstrated a positive correlation with estimated glomerular filtration rates at 1 month ( ρ = 2.570, P = .022), 3 months ( ρ = 3.210, P = .027), and 6 months ( ρ = 2.860, P = .019) after therapy. Thus, the dd‐cfDNA assay shows prognostic capabilities in therapy outcome and allograft recovery; however, its ability is inhibited by methylprednisolone regardless of the types of rejection. Additionally, a reassessment of frequency intervals for testing is required.