ArticleJornal brasileiro de nefrologia
Diagnostic performance of donor-derived cell-free DNA for acute rejection in kidney allograft biopsies.
Article in Jornal brasileiro de nefrologia. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo determine the performance of donor-derived cell-free DNA (dd-cfDNA) as a noninvasive biomarker for the diagnosis of acute rejection in for-cause kidney transplant biopsies.
methodsThis cross-sectional single-center study (between May 2021 and June 2022) included for-cause biopsies performed in kidney transplant recipients with acute graft dysfunction (AGD) or suboptimal graft function (SGF). dd-cfDNA levels were correlated with histological diagnosis according to the Banff 2022 classification.
resultsAmong 492 biopsies, 80.7% were performed for AGD and 19.3% for SGF. The distribution of histological phenotypes was 10.2% (category 1), 6.5% (category 2), 6.9% (category 3), 7.9% (category 4), 33.3% (category 5), and 35.2% (category 6). The respective median dd-cfDNA values were 0.25% (IQR 0.16-0.46), 1.88% (IQR 0.92-5.11), 0.45% (IQR 0.26-0.63), 0.51% (IQR 0.34-1.11), 0.27% (IQR 0.15-0.45), and 0.38% (IQR 0.23-0.64). Category 2 presented a higher median dd-cfDNA compared with the other groups (p < 0.001). The area under the curve (AUC) was 0.77 for acute rejection (categories 2 and 4), with a sensitivity of 50.7%, a specificity of 91.2%, a positive predictive value of 49.3%, a negative predictive value of 91.6%, and an accuracy of 85.4%. Similar results were observed in biopsies for AGD or SGF. The dd-cfDNA with the highest diagnostic performance for acute rejection was 0.81%, with optimal thresholds of 0.46% for AGD and 0.81% for SGF biopsies.
conclusionIn this cohort, dd-cfDNA showed moderate diagnostic performance for acute graft rejection and high negative predictive value. dd-cfDNA threshold diagnostic varied according to the type of for-cause biopsies (AGD or SGF).
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