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Association Between Total Cell Free DNA and SARS-CoV-2 In Kidney Transplant Patients: A Preliminary Study.

Jose Otto Reusing1, Jongwon Yoo2, Amishi Desai2

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Elevated cell-free DNA (cfDNA) in kidney transplant recipients with COVID-19 may mask rejection. Monitoring total cfDNA is crucial for accurate donor-derived cfDNA (dd-cfDNA) interpretation during infection.

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Area of Science:

  • Nephrology
  • Transplant Immunology
  • Infectious Diseases

Background:

  • Kidney transplant (KT) recipients face severe COVID-19 risks.
  • Lowering immunosuppression aids immune response but risks rejection.
  • Donor-derived cell-free DNA (dd-cfDNA) detects KT rejection.

Purpose of the Study:

  • Investigate total and dd-cfDNA levels in KT recipients with COVID-19.
  • Assess the impact of infection on dd-cfDNA as a rejection biomarker.

Main Methods:

  • Retrospective analysis of 29 KT recipients hospitalized with COVID-19.
  • Measured total and dd-cfDNA levels post-infection onset and during recovery.

Main Results:

  • Total cfDNA levels were elevated during COVID-19 (median 7.9 MoM), decreasing post-infection.
  • Higher total cfDNA correlated with COVID-19 severity.
  • Two rejections were missed due to low dd-cfDNA fractions (<1%) amid high total cfDNA.

Conclusions:

  • Elevated total cfDNA in infected KT patients can obscure dd-cfDNA results.
  • Accurate rejection assessment requires considering total cfDNA levels.
  • Total cfDNA monitoring is vital for interpreting dd-cfDNA in infected KT recipients.