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Medical Science Monitor Basic Research


eISSN: 2329-0358

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Clinical Rationale for a Routine Testing Schedule Using Donor-Derived Cell-Free DNA After Kidney Transplantation

Akshta Pai, Joshua T. Swan ORCID logo, David Wojciechowski, Yasir Qazi, Sham Dholakia, Grigoriy Shekhtman, Anas Abou-Ismail, Dhiren Kumar ORCID logo

(Division of Renal Diseases and Hypertension, University of Texas McGovern Medical School, Houston, TX, USA)

Ann Transplant 2021; 26:e932249

DOI: 10.12659/AOT.932249

ABSTRACT: Kidney transplant recipients require meticulous clinical and laboratory surveillance to monitor allograft health. Conventional biomarkers, including serum creatinine and proteinuria, are lagging indicators of allograft injury, often rising only after significant and potentially irreversible damage has occurred. Immunosuppressive medication levels can be followed, but their utility is largely limited to guiding dosing changes or assessing adherence. Kidney biopsy, the criterion standard for the diagnosis and characterization of injury, is invasive and thus poorly suited for frequent surveillance.
Donor-derived cell-free DNA (dd-cfDNA) is a sensitive, noninvasive, leading indicator of allograft injury, which offers the opportunity for expedited intervention and can improve long-term allograft outcomes. This article describes the clinical rationale for a routine testing schedule utilizing dd-cfDNA surveillance at months 1, 2, 3, 4, 6, 9, and 12 during the first year following kidney transplantation and quarterly thereafter. These time points coincide with major immunologic transition points after transplantation and provide clinicians with molecular information to help inform decision making.

Keywords: biomarkers, Cell-Free Nucleic Acids, Graft Rejection, Immunologic Surveillance, Kidney Transplantation, Pathology, Molecular

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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