Li Carol, Wright Sheavonnie, Lamba Perola, Zhou Mingming, Xu Hua, Sharma Vijay, Seshan Surya, Vaskova Evgeniya, Sulejmani Nimisha, Schillebeeckx Ian, Dadhania Darshana, Muthukumar Thangamani, Woodward Robert, Suthanthiran Manikkam
Division of Nephrology and Hypertension, Department of Medicine, New York-Presbyterian-Weill Cornell Medicine, New York, NY.
CareDx Inc, Brisbane, CA.
Transplantation. 2025 Jul 1;109(7):1209-1221. doi: 10.1097/TP.0000000000005355. Epub 2025 Mar 6.
Deciphering the impact of invasive percutaneous core needle biopsy of the kidney allograft on diagnostic biomarkers may help guide their clinical usage.
We prospectively enrolled 39 adult kidney allograft recipients (patients) who underwent 41 clinically indicated, ultrasound-guided, percutaneous core needle biopsies. Pre- and post-biopsy urines were analyzed for urinary cell 3-gene signature score (UroMap), and the bloods for peripheral blood gene expression score (AlloMap Kidney) and plasma donor-derived cell-free DNA percentage (dd-cfDNA). We performed statistical analyses to compare pre- and post-biopsy values.
Median A260/A280 ratios of RNA from pre- and post-biopsy urines were 1.99 and 2.01, respectively; RNA yield, 0.78 versus 0.76 micrograms; and transcript copies of 18S rRNA, TGFβ1, CD3ε, CXCL10, and UroMap score were similar (all P > 0.05, Wilcoxon matched-pairs signed-rank test). The pre- and post-scores were very strongly correlated (Spearman's correlation coefficient [r s ]: 0.83, P < 0.0001). AlloMap Kidney scores in pre- and post-biopsy peripheral blood were similar ( P > 0.05) and strongly correlated (r s = 0.70, P < 0.0001). dd-cfDNA in post-biopsy plasma was higher than in pre-biopsy plasma (0.61% versus 0.26%, P = 0.004). The higher post-biopsy percentage was replicated in an independent cohort of 119 post-biopsy plasma collected from 105 patients with no rejection biopsies. To normalize the biopsy-associated increase, a correction factor of -0.36% was derived by subtracting the pre-biopsy dd-cfDNA percent from the post-biopsy percent.
UroMap and AlloMap Kidney scores are not affected by the biopsy procedure. However, dd-cfDNA increases following the biopsy procedure and could be normalized using the correction factor identified in this study.
解读肾移植活体组织穿刺针吸活检对诊断生物标志物的影响可能有助于指导其临床应用。
我们前瞻性纳入了39例接受41次临床指征性超声引导下肾移植活体组织穿刺针吸活检的成年肾移植受者（患者）。对活检前后的尿液进行尿细胞3基因特征评分（UroMap）分析，对血液进行外周血基因表达评分（AlloMap Kidney）和血浆供体来源的游离DNA百分比（dd-cfDNA）分析。我们进行了统计分析以比较活检前后的值。
活检前后尿液RNA的A260/A280比值中位数分别为1.99和2.01；RNA产量分别为0.78微克和0.76微克；18S rRNA、TGFβ1、CD3ε、CXCL10的转录本拷贝数和UroMap评分相似（所有P>0.05，Wilcoxon配对符号秩检验）。活检前后的评分高度相关（斯皮尔曼相关系数[r s]：0.83，P<0.0001）。活检前后外周血中的AlloMap Kidney评分相似（P>0.05）且高度相关（r s = 0.70，P<0.0001）。活检后血浆中的dd-cfDNA高于活检前血浆（0.61%对0.26%，P = 0.004）。在从105例无排斥活检患者中收集的119份活检后血浆的独立队列中重复了活检后较高的百分比。为了标准化活检相关的增加，通过从活检后百分比中减去活检前dd-cfDNA百分比得出校正因子-0.36%。
UroMap和AlloMap Kidney评分不受活检程序影响。然而，活检后dd-cfDNA增加，并且可以使用本研究中确定的校正因子进行标准化。
