Abstract
Donor-derived cell-free DNA (dd-cfDNA) is a non-invasive biomarker that is more sensitive and specific towards diagnosing any graft injury or rejection. Due to its applicability over all transplanted organs irrespective of age, sex, race, ethnicity, and the non-requirement of a donor sample, it emerges as a new gold standard for graft health and rejection monitoring. Published research articles describing the role and efficiency of dd-cfDNA were identified and scrutinized to acquire a brief understanding of the history, evolution, emergence, role, efficiency, and applicability of dd-cfDNA in the field of transplantation. The dd-cfDNA can be quantified using quantitative PCR, next-generation sequencing, and droplet digital PCR, and there is a commendatory outcome in terms of diagnosing graft injury and monitoring graft health. The increased levels of dd-cfDNA can diagnose the rejection prior to any other presently used biochemistry or immunological assay methods. Biopsies are performed when these tests show any signs of injury and/or rejection. Therefore, by the time these tests predict and show any unusual or improper activity of the graft, the graft is already damaged by almost 50%. This review elucidates the evolution, physiology, techniques, limitations, and prospects of dd-cfDNA as a biomarker for post-transplant graft damage and rejection.
Highlights
(GcfDNA) or donor-specific DNA, is a biomarker which works on the principle/fact that an organ transplant is not just a transplant of an organ and the transplant of a genome
The pertinent questions that open the purview of the discussion concerning “whether dd-cfDNA is cleared out from the body through urine?” and “Is increased level of ddcfDNA associated with impaired kidney function rather than actual graft damage?” Some insight can be gained even though it is unknown which mechanism is involved in clearing out the cell-free DNA from the blood plasma of the recipient, but a study on foetal DNA
Several studies have clinically validated the utility of dd-cfDNA in monitoring graft damage and diagnosing rejection
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Due to the huge gap between the need and availability of organs, one cannot risk an organ failure after a transplant, owing merely to the immune response. To overcome this several measures are taken at each step, right from the beginning where the best suitable match for the organ is searched for, succeeded by the advanced medications and immunotherapy given to the recipients in order to suppress the immune response, until the enhanced post-transplant patient care. Heart failure is a global health issue, with a prevalence of over 23 million cases worldwide [16]. We believe that this review will inspire researchers to carry out further research in the field and add to the existing body of knowledge
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