Combining Blood Gene Expression and Cellfree DNA to Diagnose Subclinical Rejection in Kidney Transplant Recipients

Clin J Am Soc Nephrol. 2021 Oct;16(10):1539-1551. doi: 10.2215/CJN.05530421.ABSTRACTBACKGROUND AND OBJECTIVES: Subclinical acute rejection is associated with poor outcomes in kidney transplant recipients. As an alternative to surveillance biopsies, noninvasive screening has been established with a blood gene expression profile. Donor-derived cellfree DNA (cfDNA) has been used to detect rejection in patients with allograft dysfunction but not tested extensively in stable patients. We hypothesized that we could complement noninvasive diagnostic performance for subclinical rejection by combining a donor-derived cfDNA and a gene expression profile assay.DESIGN, SETTING, PARTICIPANTS, &MEASUREMENTS: We performed a post hoc analysis of simultaneous blood gene expression profile and donor-derived cfDNA assays in 428 samples paired with surveillance biopsies from 208 subjects enrolled in an observational clinical trial (Clinical Trials in Organ Transplantation-08). Assay results were analyzed as binary variables, and then, their continuous scores were combined using logistic regression. The performance of each assay alone and in combination was compared.RESULTS: For diagnosing subclinical rejection, the gene expression profile demonstrated a negative predictive value of 82%, a positive predictive value of 47%, a balanced accuracy of 64%, and an area under the receiver operating curve of 0.75. The donor-derived cfDNA assay showed similar negative predictive value (84%), positive p...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Source Type: research

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ConclusionsThe results of the presented study suggest that rs231775 and rs5742909 ofCTLA4 genetic variants are not linked to acute rejection who underwent kidney transplantation. So, these variants cannot be considered as risk factors of acute allograft rejection in a group of Iranian renal transplantation recipients. However, the transplantation precision medicine may be an important area for the improvement of patients outcome as the precision medicine has already entered clinical practice in kidney transplantation.
Source: Journal of Diabetes and Metabolic Disorders - Category: Endocrinology Source Type: research
CONCLUSIONS C1q⁺/C3d⁺ dnDSA were associated with C4d⁺ AMR and high-IgG MFI. Our data call into question the predictive utility of C1q/C3d-binding assays in identifying KTx recipients at risk of allograft failure. In conclusion, IgG MFI is sufficient for clinical management, and the C1q/C3d-assays with added cost do not provide any additional information.PMID:34848674 | DOI:10.12659/AOT.934175
Source: Annals of Transplantation - Category: Transplant Surgery Authors: Source Type: research
Arch Esp Urol. 2021 Dec;74(10):964-969.ABSTRACTKidney transplantation is the treatment of choice for patients with end-stage renal disease (ESRD)as it has shown a better quality of life and longer survival compared to dialysis. Patients with ESRD have associated vascular pathology in a significant percentage, with abundant calcifications at the level of the aorto-iliac axis.The survival of transplanted patients has also increased so an important number of patients have multiple transplants,patients with an indication for a third, fourth and even fifth transplant.In these cases, in which the iliac fossa is no longer practic...
Source: Archivos Espanoles de Urologia - Category: Urology & Nephrology Authors: Source Type: research
Arch Esp Urol. 2021 Dec;74(10):922-932.ABSTRACTRenal transplantation remains the best treatment option of renal replacement for end-stagechronic kidney disease. Surgical advances in graft quality and implantation techniques have improved transplantation during the last two decades. This has reduced both urologic and vascular complications after implantation. A detailed understanding of renal graft and transplantation anatomy is important to reduce transplantation morbidity. The aim of this article is to provide a detailed anatomic description of the kidney and regions usually involved in human renal transplantation (iliac ...
Source: Archivos Espanoles de Urologia - Category: Urology & Nephrology Authors: Source Type: research
Arch Esp Urol. 2021 Dec;74(10):964-969.ABSTRACTKidney transplantation is the treatment of choice for patients with end-stage renal disease (ESRD)as it has shown a better quality of life and longer survival compared to dialysis. Patients with ESRD have associated vascular pathology in a significant percentage, with abundant calcifications at the level of the aorto-iliac axis.The survival of transplanted patients has also increased so an important number of patients have multiple transplants,patients with an indication for a third, fourth and even fifth transplant.In these cases, in which the iliac fossa is no longer practic...
Source: Archivos Espanoles de Urologia - Category: Urology & Nephrology Authors: Source Type: research
Arch Esp Urol. 2021 Dec;74(10):922-932.ABSTRACTRenal transplantation remains the best treatment option of renal replacement for end-stagechronic kidney disease. Surgical advances in graft quality and implantation techniques have improved transplantation during the last two decades. This has reduced both urologic and vascular complications after implantation. A detailed understanding of renal graft and transplantation anatomy is important to reduce transplantation morbidity. The aim of this article is to provide a detailed anatomic description of the kidney and regions usually involved in human renal transplantation (iliac ...
Source: Archivos Espanoles de Urologia - Category: Urology & Nephrology Authors: Source Type: research
CONCLUSIONS C1q⁺/C3d⁺ dnDSA were associated with C4d⁺ AMR and high-IgG MFI. Our data call into question the predictive utility of C1q/C3d-binding assays in identifying KTx recipients at risk of allograft failure. In conclusion, IgG MFI is sufficient for clinical management, and the C1q/C3d-assays with added cost do not provide any additional information.PMID:34848674 | DOI:10.12659/AOT.934175
Source: Annals of Transplantation - Category: Transplant Surgery Authors: Source Type: research
Since the introduction of simultaneous liver-kidney transplantation (SLKT) in the 1960s, the potential for immunological protection from the liver allograft to a simultaneously transplanted kidney has been recognized. Due to expanded indications and changes in allocation policies, there has been increased utilization of SLKT. Despite growing experience, a lack of consensus exists regarding the extent of the immunological privilege of the liver the role for donor-specific HLA antibody (DSA) and crossmatch testing, and appropriateness of modern immunosuppression protocols in SLKT recipients. This review provides a detailed a...
Source: Transplantation - Category: Transplant Surgery Tags: Reviews Source Type: research
Conclusions. Chronic NoV infection is associated with reduced allograft function. Administration of IVIg to patients with chronic NoV infection seems beneficial in achieving freedom from clinical symptoms, despite limited effects on shedding of virus.
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research
No abstract available
Source: Transplantation - Category: Transplant Surgery Tags: Letters to the Editor Source Type: research
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