Review
Copyright ©The Author(s) 2020.
World J Transplant. Sep 18, 2020; 10(9): 230-255
Published online Sep 18, 2020. doi: 10.5500/wjt.v10.i9.230
Table 5 Summary of donor-derived cell-free deoxyribonucleic acid biomarkers associated with immunologic outcomes
Ref.nSampleBiomarkersOutcomeStudy conclusion
Oellerich et al[35], 2019189Plasmadd-cfDNARejectionIn pts with BPR, dd-cfDNA(cp/mL) was 3.3x and dd-cfDNA(%) 2.0x higher (82 cp/mL; 0.57%) than in stable pts w/o rejection (25 cp/mL; 0.29%). dd-cfDNA abs number > dd-cfDNA % (AUC = 0.73). OR = 7.31 for dd-cfDNA (cp/mL)
Stites et al[36], 202079 KTRs with TCMR 1A/borderline rejectionPlasmadd-cfDNAeGFR, dnDSA, Future rejection↑dd-cfDNA predict adverse outcomes: Among patients with ↑dd-cfDNAa, eGFR ↓ by 8.5% vs 0% in ↓dd-cfDNA pts. dnDSA seen in 40% (17/42) vs2.7%b and future or persistent rejection occurred in 9 of 42 ptsa (21.4% vs 0%)
Bloom et al[38], 2017102Plasmadd-cfDNARejectionDistinguished any rejection from non-rejection along with ABMR from non-ABMR
Huang et al[40], 201963Plasmadd-cfDNAABMRdd-cfDNA discriminated ABMRc [median 1.35%; interquartile range (IQR): 1.10%-1.90%] from no rejection (median 0.38%, IQR: 0.26%-1.10%). dd-cfDNA did not distinguish TCMR from no rejection
Whitlam et al[41], 201961Plasmadd-cfDNAaABMR cABMRgd-cfDNA and fraction were predictive of aAMR (AUC = 0.92, 0.85) and composite dx of ABMR (AUC = 0.91, 0.89). gd-cfDNA w/ modest sensitivity (0.90; 0.85) and specificity (0.88, 0.79) for aAMR and ABMR
aP < 0.005 vs low level dd-cfDNA pts.
bP < 0.0001 vs low level dd-cfDNA pts.
cP < 0.001 vs no rejection. dd-cfDNA: Donor derived-cell free deoxyribonucleic acid; Abs: Absolute; BPR: Biopsy proven rejection; AUC: Area under the curve; OR: Odds ratio; KTRs: Kidney transplant recipients; TCMR: T cell-mediated rejection; eGFR: Estimated glomerular filtration rate; dnDSA: De novo donor specific antibodies; ABMR: Antibody-mediated rejection; cABMR: Chronic antibody-mediated rejection; IQR: Interquartile range; dx: Diagnosis; aAMR: Acute antibody-mediated rejection; aABMR: Acute antibody mediated rejection; gd-cfDNA: Graft-derived cell-free DNA; Pts: Patients.