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Review
. 2021 Jan 7;10(2):193.
doi: 10.3390/jcm10020193.

Donor-Derived Cell-Free DNA in Kidney Transplantation as a Potential Rejection Biomarker: A Systematic Literature Review

Adrian Martuszewski  1 , Patrycja Paluszkiewicz  1 , Magdalena Król  2 , Mirosław Banasik  1 , Marta Kepinska  3
Affiliations
Review

Donor-Derived Cell-Free DNA in Kidney Transplantation as a Potential Rejection Biomarker: A Systematic Literature Review

Adrian Martuszewski et al. J Clin Med. .

Abstract

Kidney transplantation (KTx) is the best treatment method for end-stage kidney disease. KTx improves the patient's quality of life and prolongs their survival time; however, not all patients benefit fully from the transplantation procedure. For some patients, a problem is the premature loss of graft function due to immunological or non-immunological factors. Circulating cell-free DNA (cfDNA) is degraded deoxyribonucleic acid fragments that are released into the blood and other body fluids. Donor-derived cell-free DNA (dd-cfDNA) is cfDNA that is exogenous to the patient and comes from a transplanted organ. As opposed to an invasive biopsy, dd-cfDNA can be detected by a non-invasive analysis of a sample. The increase in dd-cfDNA concentration occurs even before the creatinine level starts rising, which may enable early diagnosis of transplant injury and adequate treatment to avoid premature graft loss. In this paper, we summarise the latest promising results related to cfDNA in transplant patients.

Keywords: KTx; cfDNA; dd-cfDNA; graft failure; kidney; liquid biopsy; rejection biomarker.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of cell-free DNA (cfDNA). Kidney transplantation (KTx) is captured here to highlight its dual function—as a kidney after other transplants and as a transplanted kidney. dd-cell-free DNA in a kidney transplant is secreted by donor-derived urinary tract and secreted into the blood.
Figure 2
Figure 2
Pre-analytical stages to optimise the extraction process (modified based on Bronkhorst et al. [37]).
Figure 3
Figure 3
A flow chart showing the progression from KTx to premature graft loss. cfDNA may be a biomarker indicative of graft injury at a very early stage.
See this image and copyright information in PMC

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