Association of initial post-transplant donor-derived cell-free dna levels with peri-transplant outcomes and donor characteristics in deceased donor kidney transplant recipients: a single-center retrospective study

The Journal of Urology(2023)

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You have accessJournal of UrologyCME1 Apr 2023MP31-12 ASSOCIATION OF INITIAL POST-TRANSPLANT DONOR-DERIVED CELL-FREE DNA LEVELS WITH PERI-TRANSPLANT OUTCOMES AND DONOR CHARACTERISTICS IN DECEASED DONOR KIDNEY TRANSPLANT RECIPIENTS: A SINGLE-CENTER RETROSPECTIVE STUDY Conner Lombardi, Jacob Lang, Emile Garcia, Mary Lee Brown, Dinkar Kaw, Deepak Malhotra, Shobha Ratnam, Michael Rees, and Obi Ekwenna Conner LombardiConner Lombardi More articles by this author , Jacob LangJacob Lang More articles by this author , Emile GarciaEmile Garcia More articles by this author , Mary Lee BrownMary Lee Brown More articles by this author , Dinkar KawDinkar Kaw More articles by this author , Deepak MalhotraDeepak Malhotra More articles by this author , Shobha RatnamShobha Ratnam More articles by this author , Michael ReesMichael Rees More articles by this author , and Obi EkwennaObi Ekwenna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Donor-derived cell-free DNA has been demonstrated as an accurate biomarker and risk predictor for acute rejection in kidney transplantation, but it’s association with other clinical variables implicated in rejection have been mixed. The aim of this study was to assess the clinical association of dd-cfDNA levels that have been associated with peri-transplant outcomes including development of delayed graft function, cold ischemia time (CIT), use of machine perfusion, and donor characteristics, including deceased donor mode of death, kidney donor profile index (KDPI), and donor age. METHODS: Retrospective data from a cohort of 84 deceased donor kidney recipients transplanted from November 2019 to December 2020 with initial dd-cfDNA (ProsperaÔ, Natera, Inc.) levels collected within six months (Median date of collection 19 days; IQR 16-31 days) of undergoing transplantation were included in the study. Pearson’s C2, Wilcoxon rank-sum tests, and linear regression with Pearson’s correlation coefficient were used to measure association with significance determined at p<0.05. RESULTS: When examining peri-transplant characteristics, mean levels of dd-cfDNA were significantly higher in those with DGF (n=20) than non-DGF (n=64) [1.02% (95% CI 0.65-1.39%) vs. 0.65 (95% CI 0.42-0.88%); p=0.002]. Dd-cfDNA levels were not significantly associated with CIT (mean p=.744, r=.036), or machine perfusion (n=45) versus no machine perfusion(n=39) (0.85% (95% CI 0.52%-1.19%) vs. 0.60% (95% CI 0.41%-0.78%); p=.32). When examining donor characteristics, dd-cfDNA levels in were significantly higher in recipients with donation after cardiac death (DCD) kidneys versus donation after brainstem death (DBD) kidneys [1.26% (95% CI 0.75%-1.76%) vs. 0.53% (95% CI 0.36%-0.69%); p=0.000]. Donor age (p=.271, r=0.12) and KDPI (p=0.15, r=0.16) were not significantly associated with dd-cfDNA levels. CONCLUSIONS: Dd-cfDNA levels were significantly elevated in patients who had DGF and in recipients of DCD kidneys in our single center cohort. Notably, machine perfusion, donor age, KDPI, and CIT were not associated with increased levels with of dd-cfDNA. As associations of these variables in the literature are thus far varied, studies with increased sample size are necessary to determine the true associations. Source of Funding: The authors declare no sources of funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e434 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Conner Lombardi More articles by this author Jacob Lang More articles by this author Emile Garcia More articles by this author Mary Lee Brown More articles by this author Dinkar Kaw More articles by this author Deepak Malhotra More articles by this author Shobha Ratnam More articles by this author Michael Rees More articles by this author Obi Ekwenna More articles by this author Expand All Advertisement PDF downloadLoading ...
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dna,post-transplant,donor-derived,cell-free,peri-transplant,single-center
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