Abstract
Since its first detection in 1948, donor-derived cell-free DNA (dd-cfDNA) has been employed for a myriad of indications in various medical specialties. It has had a far-reaching impact in solid organ transplantation, with the most widespread utilization in kidney transplantation for the surveillance and detection of allograft rejection. The purpose of this review is to track the arc of this revolutionary test—from origins to current use—along with examining challenges and future prospects though the lens of transplant nephrology.
Highlights
The practice of kidney transplantation has made immense progress in the last two decades, with sustained improvement in allograft longevity and patient outcomes
The surveillance of allograft function has traditionally relied on serum creatinine, urinary indices and kidney biopsy
Serum creatinine and urinary indices are not specific for identifying allograft rejection, while the gold standard of kidney biopsy is associated with high cost, sampling errors, risk of bleeding and organ injury [1]
Summary
The practice of kidney transplantation has made immense progress in the last two decades, with sustained improvement in allograft longevity and patient outcomes. The utilization of dd-cfDNA entered mainstream solid organ transplantation with its first demonstration in the plasma of kidney and liver transplant recipients in 1998 [6]. This finding was preceded by the theory that dd-cfDNA was present in the recipient plasma while investigating donor microchimerisms post-transplantation [7]. These findings have generated multiple studies that have confirmed its use in detecting allograft rejection and beyond
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