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作为肾移植排斥反应和移植物损伤标志物的供体游离 DNA 绝对定量:前瞻性观察研究结果。

Absolute quantification of donor-derived cell-free DNA as a marker of rejection and graft injury in kidney transplantation: Results from a prospective observational study.

机构信息

Department of Clinical Pharmacology, University Medical Center Goettingen, Goettingen, Germany.

Central Institute for Clinical Chemistry and Laboratory Medicine, Klinikum Stuttgart, Stuttgart, Germany.

出版信息

Am J Transplant. 2019 Nov;19(11):3087-3099. doi: 10.1111/ajt.15416. Epub 2019 May 28.

Abstract

Donor-derived cell-free DNA (dd-cfDNA) is a noninvasive biomarker for comprehensive monitoring of allograft injury and rejection in kidney transplantation (KTx). dd-cfDNA quantification of copies/mL plasma (dd-cfDNA[cp/mL]) was compared to dd-cfDNA fraction (dd-cfDNA[%]) at prespecified visits in 189 patients over 1 year post KTx. In patients (N = 15, n = 22 samples) with biopsy-proven rejection (BPR), median dd-cfDNA(cp/mL) was 3.3-fold and median dd-cfDNA(%) 2.0-fold higher (82 cp/mL; 0.57%, respectively) than medians in Stable Phase patients (N = 83, n = 408) without rejection (25 cp/mL; 0.29%). Results for acute tubular necrosis (ATN) were not significantly different from those with biopsy-proven rejection (BPR). dd-cfDNA identified unnecessary biopsies triggered by a rise in plasma creatinine. Receiver operating characteristic (ROC) analysis showed superior performance (P = .02) of measuring dd-cfDNA(cp/mL) (AUC = 0.83) compared to dd-cfDNA(%) (area under the curve [AUC] = 0.73). Diagnostic odds ratios were 7.31 for dd-cfDNA(cp/mL), and 6.02 for dd-cfDNA(%) at thresholds of 52 cp/mL and 0.43%, respectively. Plasma creatinine showed a low correlation (r = 0.37) with dd-cfDNA(cp/mL). In a patient subset (N = 24) there was a significantly higher rate of patients with elevated dd-cfDNA(cp/mL) with lower tacrolimus levels (<8 μg/L) compared to the group with higher tacrolimus concentrations (P = .0036) suggesting that dd-cfDNA may detect inadequate immunosuppression resulting in subclinical graft damage. Absolute dd-cfDNA(cp/mL) allowed for better discrimination than dd-cfDNA(%) of KTx patients with BPR and is useful to avoid unnecessary biopsies.

摘要

供体来源的无细胞游离 DNA(dd-cfDNA)是一种非侵入性生物标志物,可用于全面监测肾移植(KTx)中的移植物损伤和排斥反应。在 189 例 KTx 后 1 年以上的患者中,在预设的访视中比较了血浆拷贝/ml (dd-cfDNA[cp/mL])和 dd-cfDNA 分数(dd-cfDNA[%])的 dd-cfDNA 定量。在有活检证实排斥反应(BPR)的患者(N=15,n=22 样本)中,dd-cfDNA(cp/mL)中位数高 3.3 倍,dd-cfDNA(%)中位数高 2.0 倍(分别为 82 cp/mL;0.57%)与无排斥反应的稳定期患者(N=83,n=408)相比。急性肾小管坏死(ATN)的结果与活检证实的排斥反应(BPR)无显著差异。dd-cfDNA 可识别因血浆肌酐升高而引发的不必要活检。受试者工作特征(ROC)分析显示,测量 dd-cfDNA(cp/mL)(AUC=0.83)的性能优于 dd-cfDNA(%)(AUC=0.73)(P=0.02)。dd-cfDNA(cp/mL)的诊断优势比为 7.31,dd-cfDNA(%)的诊断优势比为 6.02,分别为 52 cp/mL 和 0.43%的阈值。血浆肌酐与 dd-cfDNA(cp/mL)的相关性较低(r=0.37)。在一个患者亚组(N=24)中,dd-cfDNA(cp/mL)升高且他克莫司水平较低(<8μg/L)的患者比例明显高于他克莫司浓度较高的患者(P=0.0036),这表明 dd-cfDNA 可能检测到导致亚临床移植物损伤的免疫抑制不足。与 BPR 的 KTx 患者相比,绝对 dd-cfDNA(cp/mL)可以更好地区分,并且有助于避免不必要的活检。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3c2a/6899936/5f8b1c09f505/AJT-19-3087-g001.jpg

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