From the Research
Donor-derived cell-free DNA (dd-cfDNA) is a promising non-invasive biomarker for monitoring organ rejection in simultaneous kidney-pancreas transplant (SKPT) recipients, with levels above 1% suggesting rejection requiring further evaluation, as supported by the most recent study 1.
Key Findings
- dd-cfDNA levels can detect subclinical rejection earlier than conventional markers, allowing for prompt intervention with immunosuppressive therapy adjustments before permanent graft damage occurs 2.
- The test is typically performed monthly for the first year post-transplant, then quarterly thereafter, with more frequent testing during suspected rejection episodes.
- AlloSure values below 1% generally indicate stable graft function, while levels above 1% may suggest rejection requiring further evaluation 1.
- dd-cfDNA measurement can help differentiate rejection from graft injury, such as pancreatitis, with median values in rejection being significantly higher than in quiescence 2.
Clinical Implications
- cfDNA monitoring represents an important advancement in transplant care by providing real-time insight into graft health with minimal patient burden.
- Interpretation of dd-cfDNA levels should consider that values may be temporarily elevated during infections or other inflammatory conditions, and the test cannot always distinguish between kidney and pancreas rejection in SKPT recipients.
- The use of dd-cfDNA in combination with other non-invasive biomarkers, such as donor-specific antibodies, may provide a more comprehensive assessment of allograft health 3.
Limitations
- The test cannot always distinguish between kidney and pancreas rejection in SKPT recipients.
- Values may be temporarily elevated during infections or other inflammatory conditions.
- Further studies are needed to define the optimal cutoff values for dd-cfDNA and to determine the clinical benefit of routine prospective monitoring in SKPT recipients.