Seminar on clinical application progress of donor-derived cell-free DNA was successfully held

On March 30, an online seminar on the clinical application progress of donor-derived cell-free DNA (hereinafter referred to as dd-cfDNA) hosted by AlloDx was successfully held. With the theme of "Joining Hunan to Help Navigate New Life", this seminar summarized the clinical use experience of dd-cfDNA through retrospective cohort studies and clinical case sharing, promoted exchanges among various organ transplant centers, and contributed valuable experience to improve post-transplantation management and long-term survival of transplanted kidney function.

Organ transplant experts and professors from Shandong and Hunan provinces, as well as clinical scholars in the field of organ transplantation, conducted active and lively discussions under the auspices of Professor Wang Jianning, Vice President of the First Affiliated Hospital of Shandong First Medical University and Director of the Department of Urology, and Professor Ming Yingzi, Director of the Transplant Center of the Third Xiangya Hospital of Central South University.

Group reactive antibody (PRA) testing is one of the main methods to screen for the risk of antibody-mediated rejection (ABMR) after kidney transplantation. Negative PRA usually indicates a lower risk of ABMR, but ABMR may also occur due to negative PRA. The latest data shows that the incidence of antibody-negative ABMR is as high as 46.43%. Professor Yu Shaojie from the Second Xiangya Hospital of Central South University retrospectively analyzed the value of dd-cfDNA in the auxiliary diagnosis of PRA-negative ABMR and the role of dynamic monitoring of ABMR recurrence and persistent damage, and shared his experience and insights in medication adjustment during the treatment of ABMR.

Another risk of kidney transplant loss after kidney transplantation is the development of BK virus nephropathy (BKVN). Urinary BKV-DNA and blood BKV-DNA copy number are commonly used clinical indicators to monitor the occurrence of BKVN. When urine BKV-DNA is >1x10^7 copies/mL and blood BKV-DNA is >1x10^4 copies/mL, the guidelines recommend the need for clinical intervention and treatment. At the same time, attention should be paid to preventing the increased risk of rejection during treatment. Professor Zhang Xiaoming from the First Affiliated Hospital of Shandong First Medical University shared the accurate detection and treatment process of a BKVN case with positive urine BK virus and negative blood BK virus. When BKVN is clinically suspected but the evidence is insufficient (for example, this patient's blood BK does not show positive), dd-cfDNA detection is used to assist clinical treatment to clarify the direction, seize the window opportunity of balancing immunotherapy for the patient, and successfully restore the patient's transplanted kidney function.

The risk of rejection needs to be paid attention to during the perioperative period of kidney transplantation. Once creatinine rebounds and urine output decreases, the clinic must determine whether it is caused by rejection as soon as possible and actively treat it. Otherwise, the transplanted kidney may lose function and the patient will have to return to dialysis. Professor Ding Xiang from the First Xiangya Hospital of Central South University shared his experience in the diagnosis and treatment of a case of TMA caused by perioperative ABMR after kidney transplantation. He used dd-cfDNA detection combined with puncture biopsy to quickly and accurately diagnose the type of rejection during the perioperative period. After the rejection was diagnosed, the diagnosis and treatment effect was evaluated by monitoring dd-cfDNA to provide more clinical basis for subsequent treatment. After reasonable and precise medication, the patient's creatinine was reduced to a stable state, and the function of the transplanted kidney was ultimately preserved.

The guest professors present at the meeting, under the auspices of Professors Wang Jianning and Ming Yingzi, had a lively discussion on the cases of the three speakers and shared their insights from their respective diagnosis and treatment practices. The atmosphere of exchange was very lively.

Professor Wang Jianning concluded that post-transplant testing requires comprehensive consideration of various indicators. When a patient's renal function becomes abnormal, it is necessary to systematically investigate factors that may affect donor kidney function—such as donor quality, recipient primary disease, biopsy pathology, serological tests, immune function, dd-cfDNA liquid biopsy, and medication regimen—and make multi-dimensional comprehensive judgments to achieve precise symptomatic treatment, which tests the overall capability of clinicians. Through experience exchange among centers, existing experience can be rapidly consolidated into practice, better and faster accumulating 'battle' experience against post-transplant rejection and infection, and more precisely safeguarding patients' post-transplant quality of life.