Session: MP31: Renal Transplantation & Vascular Surgery I
MP31-12: Association of initial post-transplant donor-derived cell-free DNA levels with peri-transplant outcomes and donor characteristics in deceased donor kidney transplant recipients: a single-center retrospective study
Introduction: Donor-derived cell-free DNA has been demonstrated as an accurate biomarker and risk predictor for acute rejection in kidney transplantation, but it’s association with other clinical variables implicated in rejection have been mixed. The aim of this study was to assess the clinical association of dd-cfDNA levels that have been associated with peri-transplant outcomes including development of delayed graft function, cold ischemia time (CIT), use of machine perfusion, and donor characteristics, including deceased donor mode of death, kidney donor profile index (KDPI), and donor age. Methods: Retrospective data from a cohort of 84 deceased donor kidney recipients transplanted from November 2019 to December 2020 with initial dd-cfDNA (ProsperaÔ, Natera, Inc.) levels collected within six months (Median date of collection 19 days; IQR 16-31 days) of undergoing transplantation were included in the study. Pearson’s C2, Wilcoxon rank-sum tests, and linear regression with Pearson’s correlation coefficient were used to measure association with significance determined at P<0.05. Results: When examining peri-transplant characteristics, mean levels of dd-cfDNA were significantly higher in those with DGF (n=20) than non-DGF (n=64) [1.02% (95% CI 0.65-1.39%) vs. 0.65 (95% CI 0.42-0.88%); P=0.002]. Dd-cfDNA levels were not significantly associated with CIT (mean P=.744, r=.036), or machine perfusion (n=45) versus no machine perfusion(n=39) (0.85% (95% CI 0.52%-1.19%) vs. 0.60% (95% CI 0.41%-0.78%); P=.32). When examining donor characteristics, dd-cfDNA levels in were significantly higher in recipients with donation after cardiac death (DCD) kidneys versus donation after brainstem death (DBD) kidneys [1.26% (95% CI 0.75%-1.76%) vs. 0.53% (95% CI 0.36%-0.69%); P=0.000]. Donor age (P=.271, r=0.12) and KDPI (P=0.15, r=0.16) were not significantly associated with dd-cfDNA levels. Conclusions: Dd-cfDNA levels were significantly elevated in patients who had DGF and in recipients of DCD kidneys in our single center cohort. Notably, machine perfusion, donor age, KDPI, and CIT were not associated with increased levels with of dd-cfDNA. As associations of these variables in the literature are thus far varied, studies with increased sample size are necessary to determine the true associations. SOURCE OF Funding: The authors declare no sources of funding.
