Clinical Management of Pregnant Transplant Recipients: Utilization of Fetal Fraction and dd-cfDNA

Document Type

Conference Proceeding

Publication Date

6-1-2023

Publication Title

Am J Transplant

Abstract

Purpose: One of many benefits of kidney transplant (KT) is restoration of fertility in women allowing the option to conceive. However, pregnancy in this population poses significant maternal and fetal challenges. Tools to accurately monitor for allograft rejection during pregnancy are non-specific and biopsy of the allograft can in some cases lead to unintended complications. Immunosuppression management is also complicated due to vast physiologic changes during pregnancy. Utilization of fetal and donor-derived cell-free DNA (dd-cfDNA) may provide better insights for management. Methods: This is a prospective, multi-center, observational study of KT patients undergoing dd-cfDNA (AlloSure, CareDx) monitoring monthly during pregnancy. All KT patients undergo dd-cfDNA surveillance as standard of care. The samples were interrogated for different genomes to quantify fetal fraction (FF) and ddcfDNA. The Kruskal-Wallis test was performed to analyze the dd-cfDNA and FF across time points. Results: Total of 7 KT recipients were included in this analysis. Of those, 5 had live births, 1 had a miscarriage, and 1 is ongoing. Complications during pregnancy included pre-eclampsia (2), post-partum bleeding (2), and allograft rejection (1). One patient was treated for clinical rejection during pregnancy due to rise in serum creatinine (1.3 to 1.7), however, the correlating dd-cfDNA remained stable at 0.23% indicating lack of rejection. Overall, FF significantly increased from 1stto 3rdtrimester (p<0.0003 (figure1a)) as expected due to increase in fetal mass. The dd-cfDNA did not differ across 3 trimesters (Figure 1b) indicating lack of injury to kidney allograft. The evolution of FF and dd-cfDNA from pre- to post-pregnancy is described in figure 1c. Clinical parameters correlated with pregnancy related changes in transplant population rather than allograft health (figure 1d). Conclusions: Utilization of dd-cfDNA and fetal fraction provides specific insights into kidney allograft function. This can lead to optimized noninvasive monitoring and management of pregnancy in this patient population. CITATION INFORMATION: Khoury N., Jittirat A., Fu Y., Gulbahce N., Woodward R., Sulejmani N. Clinical Management of Pregnant Transplant Recipients: Utilization of Fetal Fraction and dd-cfDNA AJT, Volume 23, Issue 6, Supplement 1. DISCLOSURES: N.Khoury: n/a. A.Jittirat: n/a. Y.Fu: n/a. N.Gulbahce: Employee;; CareDX. R.Woodward: Employee;; CareDx, Stock Shareholder;; CareDx. N.Sulejmani: Employee;; CareDx. [Figure presented]

Volume

23

Issue

6

First Page

S977

Last Page

S978

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