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Abdulhadi T, Alrata L, Dubrawka C, Amurao G, Kalipatnapu SM, Isaac C, Rodrigues S, Flores KM, Alsabbagh DY, Alomar O, Alhamad T. Donor-derived cell free DNA as a biomarker in kidney transplantation. Pharmacogenomics 2023; 24:771-780. [PMID: 37732393 DOI: 10.2217/pgs-2023-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
The early detection of acute rejection in the allograft is important as it provides an opportunity for timely therapeutic intervention in order to preserve graft function and achieve longer graft survival. Donor-derived cell-free DNA (dd-cfDNA) has emerged as a new biomarker in the field of kidney transplantation. In this review, we used data from various studies to examine the role of dd-cfDNA in comparison to creatinine and donor-specific antibodies in the early detection of transplant rejection. We also reviewed the use of dd-cfDNA in other organ transplants as well as the challenges and potential future direction for dd-cfDNA as a diagnostic tool.
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Affiliation(s)
- Tarek Abdulhadi
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Louai Alrata
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Casey Dubrawka
- Department of Pharmacy, Barnes Jewish Hospital, St. Louis, MO 63110, USA
| | - Gwendolyn Amurao
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sri Mahathi Kalipatnapu
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Che Isaac
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Shelden Rodrigues
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karen Marie Flores
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Dema Yaseen Alsabbagh
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Omar Alomar
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tarek Alhamad
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Transplant Epidemiology Research Collaboration (TERC), Institute of Public Health, Washington University School of Medicine, St. Louis, MO 63110, USA
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BK Virus Nephropathy in Kidney Transplantation: A State-of-the-Art Review. Viruses 2022; 14:v14081616. [PMID: 35893681 PMCID: PMC9330039 DOI: 10.3390/v14081616] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
BK virus maintains a latent infection that is ubiquitous in humans. It has a propensity for reactivation in the setting of a dysfunctional cellular immune response and is frequently encountered in kidney transplant recipients. Screening for the virus has been effective in preventing progression to nephropathy and graft loss. However, it can be a diagnostic and therapeutic challenge. In this in-depth state-of-the-art review, we will discuss the history of the virus, virology, epidemiology, cellular response, pathogenesis, methods of screening and diagnosis, evidence-based treatment strategies, and upcoming therapeutics, along with the issue of re-transplantation in patients.
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Kant S, Brennan DC. Donor Derived Cell Free DNA in Kidney Transplantation: The Circa 2020–2021 Update. Transpl Int 2022; 35:10448. [PMID: 35721467 PMCID: PMC9198901 DOI: 10.3389/ti.2022.10448] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
The routine surveillance of kidney transplant allografts has relied on imperfect non-invasive biomarkers such as creatinine and urinary indices, while the gold standard allograft biopsy is associated with risk of bleeding, organ injury and sampling errors. Donor derived cell free DNA (dd-cfDNA) is being employed as a biomarker that addresses limitations of these surveillance methods, albeit has inherent drawbacks. This review provides an update on the enhanced understanding of dd-cfDNA and its expanded use beyond the conventional indication of detecting allograft rejection.
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Affiliation(s)
- Sam Kant
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Sam Kant,
| | - Daniel C. Brennan
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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