ArticleIJU case reports2026
Requiring Caution in the Interpretation of Donor-Derived Cell-Free DNA Levels During Cancer Treatment in a Kidney Transplant Recipient.: A Case Report.
Article in IJU case reports, 2026. 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
Introduction: Donor-derived cfDNA (dd-cfDNA) indicates allograft rejection when > 1% of total cfDNA, but tumor-derived cfDNA can interfere in cancer patients. Case Presentation: A 61-year-old male kidney transplant recipient with metastatic renal cell carcinoma (RCC) initiated avelumab and axitinib. Following two cycles of Immno-oncology (IO) therapy, serum creatinine (Cr) levels increased to 3.1 mg/dL. Although %dd-cfDNA remained below the conventional 1% threshold, it rose to 0.41%, representing a relative change value (RCV) of +178% from baseline. Two weeks later, Cr increased to 4.5 mg/dL, accompanied by severe hyponatremia, necessitating discontinuation of IO therapy, treated with methylprednisolone and resumed IO therapy; however, Cr remained elevated; he required hemodialysis. Conclusion: RCV from baseline %dd-cfDNA may serve as a more reliable indicator of allograft injury, facilitating earlier intervention in transplant recipients undergoing IO therapy.
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