Despite advances in the modern era of kidney transplantation, the rates of allograft loss remain disproportionately higher among African American transplant recipients than among non-African American recipients. According to A. Langone and colleagues, biologic and socioeconomic risk factors are associated with the persistent racial disparities in outcomes. Donor derived-cell free DNA (dd-cfDNA), as a marker of cellular injury, has been shown to have value in risk stratification.
The researchers conducted a study designed to compare the distribution of dd-cfDNA, stratified by self-reported race, to ascertain whether dd-cfDNA is a predictor of increased risk for allograft failure. Results of the study were reported during a virtual poster session at the American Transplant Congress in a poster titled Value of dd-cfDNA When Considering Recipient Ethnicity to Further Help Risk Stratify Transplant Recipients.
Patients in the DART (Diagnosing Active Rejection in Kidney Transplant Recipients) study were followed for 2 years. During the first year following kidney transplantation, dd-cfDNA (AlloSure®, CareDx, Brisbane, California) was measured up to seven times. A total of 676 samples from African American patients were compared with 1307 samples from patients of other race/ethnicity. The researchers examined the cumulative distribution of dd-cfDNA in both cohorts.
Compared with the non-African American cohort, patients in the African American cohort had significantly higher cumulative distribution of dd-cfDNA: mean 0.69 among African Americans versus 0.45 among non-African Americans, P=.0006. Events of allograft rejection were more frequent among African Americans than in the non-African American cohort (P=.0159).
When considering the dd-cfDNA cumulative distribution function for the percentage change in estimated glomerular filtration rate (eGFR) stratified by race, African American patients had a significant improvement in eGFR compared with the non-African American patients following the clinical care intervention.
In summary the researchers said, “African American [ethnicity] is a significant risk factor for transplant recipients and is associated with an increase in dd-cfDNA. The regular use of dd-cfDNA as part of post-transplant surveillance may assist in the assessment and quantification of risk, and help allow earlier intervention to improve the overall outcomes and eGFR when events occur.”
Source: Langone A, Fischbach B, Cohen D. Value of dd-cfDNA when considering recipient ethnicity to further help risk stratify transplant recipients. Abstract of a poster presented at the virtual American Transplant Congress (Abstract B-323), May 30, 2020.