Jaikaransingh V, Makadia B, Khan HS, Hasan I. Clinical use of donor-derived cell-free DNA in kidney transplantation. World J Transplant 2024; 14(4): 97219 [PMID: 39697447 DOI: 10.5500/wjt.v14.i4.97219]
Corresponding Author of This Article
Vishal Jaikaransingh, MBBS, Assistant Professor, Department of Medicine, Divison of Nephrology, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, C290, Jacksonville, FL 32209, United States. vishal.jaikaransingh@jax.ufl.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Dec 18, 2024; 14(4): 97219 Published online Dec 18, 2024. doi: 10.5500/wjt.v14.i4.97219
Clinical use of donor-derived cell-free DNA in kidney transplantation
Vishal Jaikaransingh, Bhaktidevi Makadia, Hafiz S Khan, Irtiza Hasan
Vishal Jaikaransingh, Bhaktidevi Makadia, Hafiz S Khan, Irtiza Hasan, Department of Medicine, Divison of Nephrology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, United States
Author contributions: Jaikaransingh V conceived the paper, collected data and wrote the paper; Makadia B, Khan HS, and Hasan I collected data and provided critical review of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vishal Jaikaransingh, MBBS, Assistant Professor, Department of Medicine, Divison of Nephrology, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, C290, Jacksonville, FL 32209, United States. vishal.jaikaransingh@jax.ufl.edu
Received: May 25, 2024 Revised: July 12, 2024 Accepted: July 23, 2024 Published online: December 18, 2024 Processing time: 117 Days and 9.5 Hours
Abstract
Traditional monitoring of kidney transplant recipients for allograft dysfunction caused by rejection involves serial checks of serum creatinine with biopsy of the renal allograft if dysfunction is suspected. This approach is labor-intensive, invasive and costly. In addition, because this approach relies on a rise in serum creatinine above historical baselines, injury to the allograft can be extensive before this rise occurs. In an effort to address this, donor-derived cell-free DNA (dd-cf DNA) is being used with increasing frequency in the clinical setting as a means of diagnosing a rejection of the renal allograft early in the course. This can potentially allow for early intervention to minimize not only injury, but the intensity of antirejection therapy needed and the avoidance of side effects. Here, we will review the available methodology for the determination and quantification of dd-cf DNA, the data supporting its use in clinical practice and the limitations of this technology.
Core Tip: Recently published data strongly supports the use of donor-derived cell-free DNA (dd-cf DNA) for routine monitoring of kidney transplants for injury and rejection. Commercial assays for dd-cf DNA have been available for more than 5 years and their use is growing however, older data supporting their use was limited to single center studies with small sample sizes. Within the last two years, newer data has emerged in larger, multi center studies and give further insight into the performance of this test and it's ability to diagnose kidney transplant rejection, predict patients at risk for rejection long before the clinical event and aid in treatment of rejection. This review aims to review the most recent literature and provide an argument for the inclusion of dd-cf DNA in the routine care of kidney transplant recipients.
