Performance of Donor-Derived Cell-Free Dna in Repeat Kidney Transplant Recipients

Document Type

Conference Proceeding

Publication Date

6-1-2023

Publication Title

Am J Transplant

Abstract

Purpose: Repeat kidney transplant recipients (RKTR) typically have two allografts in their abdomen, suggesting that there may be elevated levels of dd-cfDNA compared to single kidney transplant recipients (SKTR); however, initial reports have indicated minimal differences in dd-cfDNA levels between the two. We compared dd-cfDNA fractions between RKTR and SKTR in a large cohort of patients. Methods: Patients with either a SKTR or RKTR from the ProActive registry study (ClinicalTrials.gov NCT04091984) were included in this analysis. In a low-risk subcohort, which excluded patients with a rejection episode, dd-cfDNA fractions (%) (the ProsperaTMtest) were compared between SKTR and RKTR. Histology was used as the standard for determining rejection. Results: The full cohort included 9,091 blood draws from 930 patients. There were 46 biopsy matched blood draws from RKTR, including four showing rejection. The low-risk subcohort included 8,382 blood draws (866 patients; 60% male, 45% white), including 7,645 draws from 785 SKTR and 737 draws from 81 RKTR. In the low-risk subcohort, the distribution of dd-cfDNA fractions was higher in RKTR vs. SKTR (p<0.001). The 25th, 50th, 75th and 90th %ile dd-cfDNA fractions in RKTR were 36%, 55%, 108% and 166% higher than in SKTR, respectively (See Table). In the biopsy matched samples from the full cohort, 75% of RKTR with rejection (3/4) had dd-cfDNA% elevated above the 1% risk assessment threshold, while 67.7% (28/42) of non-rejections were <1%. Conclusions: The data in this study suggest that dd-cfDNA% in RKTR are higher compared to SKTR; the difference seems to be greater with higher dd-cfDNA%. More data is required to understand whether the dd-cfDNA% differences between SKTR and RKTR have a meaningful impact on clinical interpretation of dd-cfDNA. CITATION INFORMATION: Samaniego-Picota M., Demko Z., Fehringer G., Marshall K., Armer M., Tabriziani H., Bhorade S., Gauthier P., Cooper M. Performance of Donor-Derived Cell-Free Dna in Repeat Kidney Transplant Recipients AJT, Volume 23, Issue 6, Supplement 1. DISCLOSURES: M.Samaniego-picota: None. Z.Demko: n/a. G.Fehringer: n/a. K.Marshall: n/a. M.Armer: n/a. H.Tabriziani: n/a. S.Bhorade: n/a. P.Gauthier: n/a. M.Cooper: None. [Figure presented]

Volume

23

Issue

6

First Page

S972

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