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 ddcfDNA) 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 ddcfDNA 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 ddcfDNA 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), ddcfDNA 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 ddcfDNA 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 ddcfDNA 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 finally concluded that post-kidney transplant testing requires comprehensive consideration of various indicators. When a patient's renal function is abnormal, factors that may affect the donor's renal function, such as donor quality, recipient's primary disease, puncture pathology, serological examination, immune function, ddcfDNA liquid biopsy, and medication regimen, need to be checked one by one to make precise and comprehensive judgments, which will test the comprehensive strength of clinicians. Through the exchange of experiences between centers, we can quickly accumulate existing experience and turn it into practice, accumulate experience in the "fight" against postoperative rejection and infection better and faster, and more accurately protect the quality of patients' postoperative survival.