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dd-cfDNA显著提高了移植活检中的排斥率

Jonathan S Bromberg¹, Daniel C Brennan², David J Taber³

¹University of Maryland School of Medicine.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

|August 8, 2025

概括

来自捐赠者的无细胞DNA (dd-cfDNA) 有效地预测移植排斥. 较高的dd-cfDNA水平显著增加了活检证明急性排斥 (BPAR) 的可能性,优化了患者管理.

科学领域:

腎臟病學 (nephrology) 是一種醫學專業.
移植免疫学移植免疫学
生物标志物发现发现

背景情况:

免疫媒介的移植损伤是造成移植失败的主要原因之一.
早期检测排斥对于及时干预和移植存活至关重要.
来自捐赠者的无细胞DNA (dd-cfDNA) 已成为一个有前途的非侵入性生物标志物.

研究的目的:

评估dd-cfDNA在预测活检证明急性排斥 (BPAR) 中的临床实用性.
评估dd-cfDNA在不同活检指示 (监测和原因) 的表现.

主要方法:

在前性KOAR研究中,分析了1,743名移植患者的1,070个活检.
基于dd-cfDNA水平的活检分层 (升高,不升高,没有测试).
在dd-cfDNA组之间对排斥率和组织学发现进行比较.

主要成果:

增加的dd-cfDNA与明显更高的排斥率相关:39%与7% (监测) 和47%与12% (因原因) (p<0.0001).
增加的dd-cfDNA与活性抗体介导排斥 (ABMR) 和混合排斥相关.
非升高的dd-cfDNA主要表明没有排斥,边界或T细胞介导排斥 (TCMR) 1A.
对BPAR检测的接收器操作特征曲线 (AUROC) 下面的面积为0.789.

结论:

dd-cfDNA水平显著提高了移植接受者的BPAR测试前的概率.
dd-cfDNA可以通过识别最有可能发生组织学排斥的患者来优化活检利用率.
这种生物标志物有助于区分主动排斥与其他疾病,指导临床决策.

关键词:

活检的收益率是多少 KOAR (脏全移植结果与缺失注册表)NCT03326076 是一个国家.拒绝收益率是什么?dd-cfDNA 的临床实用性 dd-cfDNA 的时间.供体衍生细胞自由DNA,供体细胞自由DNA.移植后的活检活检亚临床排斥亚临床排斥监视活检检测监视活检检测

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