Enter Note
D111 - Donor-Derived Cell-Free DNA and PBMC Gene Expression Profile in Early Days Post Kidney-Transplant
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Author Block: E. Daniel1, M. Ibrahim1, R. Kalil1, R. Ugarte1, H. Ahmed1, U. Gautam1, A. Singh2, A. Haririan1, 1Medicine, University of Maryland Medical Center, Baltimore, MD, 2University of Maryland Medical Center, Baltimore, MD
*Purpose: Donor-derived cell-free DNA (dd-cfDNA) and PBMC gene expression profiling (GEP) are non-invasive biomarkers associated with antibody and cell-mediated rejections, as well as allograft injury. The utility and kinetics of these biomarkers have not been evaluated in early post-transplant period, particularly with delayed graft function (DGF). We examined the pattern of changes in these biomarkers in patients with DGF vs slow/immediate graft function and their association with graft outcomes.
*Methods: This is a single-center prospective cohort study of kidney transplant recipients between 10/2022-7/2024. DGF was defined as need for dialysis in 1st week post-transplant. dd-cfDNA (AlloSure) and GEP (AlloMap kidney) were measured on days 0,1,2,3, 7, and with DGF weekly up to day 42.
*Results: 42 patients were included in this analysis. 11 received living donor transplants. 12 were female and 22 were African American. 31 received Alemtuzumab for induction; others received rATG (4) or Basiliximab (7). 24 patients experienced DGF. The time course for both groups is summarized in the figure. The dd-cfDNA scores tended to be higher in DGF group in the first 3 days, however, there were no significant differences between the two groups. Baseline dd-cfDNA levels were achieved by 1-week in both groups. GEP scores were comparable between the two groups in all time points. 14 patients had biopsy, none with rejection. Early dd-cfDNA levels were not associated with DGF or its duration. Day 0 dd-cfDNA was associated with cold-ischemia time (ρ=0.39; p=0.033) and level>3.1 was predictive of worse graft survival.
*Conclusions: Our results suggest that dd-cfDNA and GEP are not predictive of early graft function. dd-cfDNA levels decline to baseline as early as 7-days posttransplant, and high Day 0 level is a prognostic biomarker.
| DGF group | IGF/SGF group | P value | |
| Age | 54+/-13.3 | 53.5+/-11.8 | 0.89 |
| BMI | 29+/-6.1 | 28+/-4.9 | 0.73 |
| PRA | 17.5 (0,81.5) | 2.5 (0,63) | 0.65 |
| KDPI | 56.4+/-28 | 49.8+/-28.6 | 0.55 |
| Donor male | 62.5% | 50% | 0.53 |
| CIT (h) | 18.5 (13.3,20.5) | 8.2 (1,21.7) | 0.11 |
| WIT (min) | 45.1 (41,58) | 41.5 (32,46) | 0.10 |
