AUTHOR=Zhang Huanxi , Zheng Chunting , Li Xirui , Fu Qian , Li Jun , Su Qun , Zeng Liuhong , Liu Zu , Wang Jiali , Huang Huiting , Xu Bowen , Ye Mingzhi , Liu Longshan , Wang Changxi 

TITLE=Diagnostic Performance of Donor-Derived Plasma Cell-Free DNA Fraction for Antibody-Mediated Rejection in Post Renal Transplant Recipients: A Prospective Observational Study

JOURNAL=Frontiers in Immunology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2020.00342

DOI=10.3389/fimmu.2020.00342

ISSN=1664-3224

ABSTRACT=Objectives: To evaluate the diagnostic performance of donor-derived plasma cell-free DNA (cfDNA) in discriminating antibody-mediated rejection or de novo donor-specific antibodies (DSA) without histological lesions in kidney allograft recipients.
Methods: In this prospective single center observational study, we enrolled kidney allograft recipients between November, 2016 and September, 2017 at the First Affiliated Hospital of Sun Yat-sen University. Kidney allograft recipients with antibody-mediated rejection (ABMR), de novo DSA but no histological lesions or negative DSA and stable renal function were included. The plasma cfDNA fraction was measured using a targeted, single nucleotide polymorphism(SNP)-based assay. Pathological diagnosis was made according to the 2015 Banff Kidney Rejection Classification. The area under the ROC curve (AUC-ROC) was determined using the bootstrapping method to estimate median and 95% confidence interval (95%CI). The sensitivity, specificity and Youden index, positive predictive value (PPV) and negative predictive value (NPV) were calculated for specific cfDNA fractions.
Results: Totally 37 consecutive patients received kidney allografts, including 18 recipients in the ABMR group and 19 recipients in the stable allograft group (7 DSA-positive and 12 DSA-negative). All patients in the ABMR group were DSA positive and 7 patients in the stable group were DSA positive but had no pathologically proven ABMR. The median donor-derived plasma cfDNA fraction was 2.4% (Q1 1.52% -Q3 3.70%) in the ABMR group, and was significantly higher than that of the stable group (0.65%, Q1 0.57% -Q3 0.97%; P< 0.001), but comparable with that of the DSA-positive patients in the stable allograft group (P=0.074). The AUC-ROC of cfDNA was 0.90 (95%CI, 0.79-0.98). When a cfDNA threshold of 1% was chosen, it had a sensitivity of 88.9% and a specificity of 73.7%. The PPV was 76.2% and the NPV was 87.5%.
Conclusions: Donor-derived plasma cfDNA fraction increased in kidney allograft recipients with ABMR. Detection of donor-derived plasma cfDNA fraction may contribute to the discrimination between ABMR and stable renal allograft function and may aid early recognition of earlier stage antibody-mediated injury.