Abstract
Monitoring kidney transplant recipients for evidence of allograft rejection is essential to lower the risk of graft loss. The traditional method relies on serial checks in serum creatinine with a biopsy of the allograft if dysfunction is suspected. This is invasive, labor-intensive and costly. As such, there is widespread interest in the use of biomarkers to provide a noninvasive approach to detecting allograft rejection. One such biomarker is donor-derived cell-free DNA (ddcf-DNA). Here, we review the methodology for the determination of the amount/fraction of ddcf-DNA, evaluate the available data of its use in kidney transplantation and render an opinion in the clinical decision-making of these patients.
Highlights
Studies involving cell-free DNA were performed in the 1970s in patients with cancer [1]
The technology involves the detection of disparate single nucleotide polymorphisms (SNPs) across the whole genome and allows for the separation of the DNA derived from two individuals, and is known as genome transplant dynamics (GTD)
After stabilization of the ddcf-DNA fraction after transplant, the levels can rise as a result of acute rejection but can rise when the allograft suffers other types of injury including acute tubular necrosis [18], and in the cases of severe post-transplant infection including allograft pyelonephritis and BK virus nephropathy (BKVN) [4,18,19]
Summary
Studies involving cell-free DNA (cf-DNA) were performed in the 1970s in patients with cancer [1]. In the field of solid organ transplantation, donor-derived cell-free. The amount of donor-derived cell-free DNA is usually expressed as a percentage of the total cell-free DNA present. These assays do not require genotyping of the donor or the recipient [7]. The technology involves the detection of disparate single nucleotide polymorphisms (SNPs) across the whole genome and allows for the separation of the DNA derived from two individuals, and is known as genome transplant dynamics (GTD). Elevated levels of ddcf-DNA point to injury of the allograft and in some patients can suggest acute rejection
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