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通过大规模多重聚合酶链反应评估供体来源的游离DNA优化肾移植损伤检测

Optimizing Detection of Kidney Transplant Injury by Assessment of Donor-Derived Cell-Free DNA via Massively Multiplex PCR.

作者信息

Sigdel Tara K, Archila Felipe Acosta, Constantin Tudor, Prins Sarah A, Liberto Juliane, Damm Izabella, Towfighi Parhom, Navarro Samantha, Kirkizlar Eser, Demko Zachary P, Ryan Allison, Sigurjonsson Styrmir, Sarwal Reuben D, Hseish Szu-Chuan, Chan-On Chitranon, Zimmermann Bernhard, Billings Paul R, Moshkevich Solomon, Sarwal Minnie M

机构信息

University of California San Francisco, Department of Surgery, San Francisco, CA 94143, USA.

Natera, Inc., San Carlos, CA 94070, USA.

出版信息

J Clin Med. 2018 Dec 23;8(1):19. doi: 10.3390/jcm8010019.

Abstract

Standard noninvasive methods for detecting renal allograft rejection and injury have poor sensitivity and specificity. Plasma donor-derived cell-free DNA (dd-cfDNA) has been reported to accurately detect allograft rejection and injury in transplant recipients and shown to discriminate rejection from stable organ function in kidney transplant recipients. This study used a novel single nucleotide polymorphism (SNP)-based massively multiplexed PCR (mmPCR) methodology to measure dd-cfDNA in various types of renal transplant recipients for the detection of allograft rejection/injury without prior knowledge of donor genotypes. A total of 300 plasma samples (217 biopsy-matched: 38 with active rejection (AR), 72 borderline rejection (BL), 82 with stable allografts (STA), and 25 with other injury (OI)) were collected from 193 unique renal transplant patients; dd- cfDNA was processed by mmPCR targeting 13,392 SNPs. Median dd-cfDNA was significantly higher in samples with biopsy-proven AR (2.3%) versus BL (0.6%), OI (0.7%), and STA (0.4%) ( < 0.0001 all comparisons). The SNP-based dd-cfDNA assay discriminated active from non-rejection status with an area under the curve (AUC) of 0.87, 88.7% sensitivity (95% CI, 77.7⁻99.8%) and 72.6% specificity (95% CI, 65.4⁻79.8%) at a prespecified cutoff (>1% dd-cfDNA). Of 13 patients with AR findings at a routine protocol biopsy six-months post transplantation, 12 (92%) were detected positive by dd-cfDNA. This SNP-based dd-cfDNA assay detected allograft rejection with superior performance compared with the current standard of care. These data support the feasibility of using this assay to detect disease prior to renal failure and optimize patient management in the case of allograft injury.

摘要

用于检测肾移植排斥反应和损伤的标准非侵入性方法敏感性和特异性较差。据报道,血浆供体来源的游离DNA(dd-cfDNA)能够准确检测移植受者的移植排斥反应和损伤,并在肾移植受者中显示出可区分排斥反应与稳定的器官功能。本研究使用了一种基于单核苷酸多态性(SNP)的大规模多重PCR(mmPCR)新方法,在无需事先了解供体基因型的情况下,测量各类肾移植受者的dd-cfDNA,以检测移植排斥反应/损伤。从193例独特的肾移植患者中收集了300份血浆样本(217份与活检匹配:38份有急性排斥反应(AR),72份为临界排斥反应(BL),82份移植肾稳定(STA),25份有其他损伤(OI));通过针对13392个SNP的mmPCR处理dd-cfDNA。经活检证实为AR的样本中dd-cfDNA中位数(2.3%)显著高于BL(0.6%)、OI(0.7%)和STA(0.4%)(所有比较均P<0.0001)。基于SNP的dd-cfDNA检测在预设临界值(>1% dd-cfDNA)时,区分急性排斥与非排斥状态的曲线下面积(AUC)为0.87,敏感性为88.7%(95%CI,77.7⁻99.8%),特异性为72.6%(95%CI,65.4⁻79.8%)。在移植后6个月常规方案活检发现有AR的13例患者中,12例(92%)通过dd-cfDNA检测呈阳性。与当前的标准治疗方法相比,这种基于SNP的dd-cfDNA检测在检测移植排斥反应方面具有更优的性能。这些数据支持了使用该检测方法在肾衰竭之前检测疾病并在移植肾损伤情况下优化患者管理的可行性。

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