Abstract

Standardized donor-derived cell-free DNA (dd-cfDNA) testing has been introduced into clinical use to monitor kidney transplant recipients for rejection. This report describes the performance of this dd-cfDNA assay to detect allograft rejection in samples from heart transplant (HT) recipients undergoingsurveillance monitoring across the UnitedStates. Venous blood was longitudinally sampled from 740 HT recipients from 26 centers, and in a single-center cohort of33 patients at high risk for antibody-mediated rejection (AMR). Plasma dd-cfDNA was quantified using targeted amplification and sequencing of a single nucleotide polymorphism panel. dd-cfDNA levels were correlated to paired events of biopsy-based diagnosis of rejection. The median dd-cfDNA was 0.07% in reference HT recipients (2164 samples) and 0.17% in samples classified as acute rejection (35, p=0.005). At a 0.2% threshold, dd-cfDNA had a 44% sensitivity to detect rejection and a 97% negative predictive value. In the cohort at risk for AMR (11 samples), dd-cfDNA levels were elevated threefold in AMR compared to patients without AMR (99 samples, p=0.004). The standardized dd-cfDNA test identified acute rejection in samples from a broad population of heart transplant recipients. The reported test performance characteristics will guide the next stage of clinical utility studies of the dd-cfDNA assay. This article is protected by copyright. All rights reserved.

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