Transplant International Journal Club [January]

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We will discuss the last article on dd-cfDNA https://bit.ly/47ABImn

Elevated dd-cfDNA levels reflect allograft damage, and studies have shown that dd-cfDNA can distinguish active rejection from no rejection. In this prospective study, the objective was to analyze dd-cfDNA within a group of German kidney transplant recipients.
106 kidney transplant recipients with a total of 108 graft biopsies were enrolled. Of the 108 allograft biopsies, 36 (33%) were classified as different types of rejection, where of 7 biopsies were graded as ABMR, 6 as TCMR, and 23 as borderline changes.
Patients with histopathological signs of active rejection had significantly higher levels of dd-cfDNA at time of biopsy than patients without signs for rejection, whereas estimated glomerular filtration rate (eGFR) did not differ significantly between the two groups.
dd-cfDNA levels were with a median (IQR) % of 2.00 (0.48–3.20) highest in patients with ABMR, followed by 0.92 (0.19–11.25) in patients with TCMR, 0.44 (0.20–1.10) in patients with borderline changes and 0.20 (0.11–0.53) in patients with no signs of rejection.
The AUC to discriminate any type of rejection including borderline changes from no rejection was at 0.72 (95% CI 0.62–0.83). For the discrimination of only ABMR or only TCMR from no rejection, dd-cfDNA exhibited an AUC of 0.90 (95% CI 0.78–1.00) and 0.73 (95% CI 0.47–0.99).
The optimal cut point for dd-cfDNA to discriminate active rejection from no rejection was at a threshold of 0.57, yielding a specificity of 81% (95% CI 70%–88%), a sensitivity of 53% (95% CI 37%–68%), a PPV of 58% (95% CI 41%–73%), and an NPV of 77% (95% CI 67%–85%).