What If You Could Predict Kidney Transplant Rejection Early?

Early dd-cfDNA monitoring can flag kidney transplant rejection risk years before symptoms appear.

A new window for rejection risk is here with cell-free DNA (cfDNA). Measuring donor-derived cell-free DNA (dd-cfDNA) early after renal transplant can help flag patients at elevated risk for rejection ().

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TOP INSIGHT

Patients with rising dd-cfDNA faced up to 8× higher graft loss risk-proof that DNA holds the earliest warning. #kidneyhealth #medindia

What is dd-cfDNA?

Donor organ cells shed DNA fragments into the recipient’s bloodstream upon injury or immune attack. Kidney transplants in particular allow detection through both blood and urine. Elevated urinary dd-cfDNA indicates ongoing graft injury or rejection.

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Biological Rationale & Mechanism

Of the 1778 screened patients, 1258 were analyzed, with 944 (about 75%) completing three years of follow-up. Along the three-year course, dd-cfDNA levels measured during routine surveillance testing revealed that patients in the At Surveillance—Reference Change Value (AS RCV) and those in the AS Normal group were mostly females. Risk of graft loss was significantly higher among patients with dd-cfDNA elevations.

The cumulative graft loss for the three-year follow-up:

AS Normal group - 1.4% graft loss
AS RCV group - 3.0% graft loss
AS High group - 7.7% graft loss

Higher dd-cfDNA, Higher Graft Loss Risk

The AS RCV group (hazard ratio 3.411) was more than three times more likely to experience graft loss over three years than someone with normal dd-cfDNA. In the AS High group (hazard ratio 8.166), chances were more than eight times greater. The hazard ratios were given in comparison with the normal group, and no significant differences in non-COVID mortality were observed among the three groups.

Integrating dd-cfDNA surveillance into post-transplant care could revolutionize management, enabling clinicians to intervene at an earlier stage, customize follow-up, and even lead to a lower dependence on biopsies.

"Stop Graft Rejection in Its Tracks, When Donor DNA Sends the Warning!"
Reference:

Renal Transplant Recipients with Elevated Donor-Derived Cell-Free DNA (dd-cfDNA) Are at Increased Risk of Graft Loss - (https://www.amjtransplant.org/article/S1600-6135(25)00963-3/fulltext)

Source-Medindia

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