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dc.contributor.authorStites, E.
dc.contributor.authorWeir, M.
dc.contributor.authorBromberg, J.
dc.date.accessioned2020-03-23T15:54:18Z
dc.date.available2020-03-23T15:54:18Z
dc.date.issued2020
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85081281914&doi=10.1111%2fajt.15822&partnerID=40&md5=c16941d0a722866cf8debd3d11f1ffc6
dc.identifier.urihttp://hdl.handle.net/10713/12323
dc.description.abstractThe clinical importance of subclinical, early T cell–mediated rejection (Banff TCMR 1A and borderline lesions) remains unclear, due, in part to the fact that histologic lesions used to characterize early TCMR can be nonspecific. Donor-derived cell-free DNA (dd-cfDNA) is an important molecular marker of active graft injury. Over a study period from June 2017 to May 2019, we assessed clinical outcomes in 79 patients diagnosed with TCMR 1A/borderline rejection across 11 US centers with a simultaneous measurement of dd-cfDNA. Forty-two patients had elevated dd-cfDNA (≥0.5%) and 37 patients had low levels (<0.5%). Elevated levels of dd-cfDNA predicted adverse clinical outcomes: among patients with elevated cfDNA, estimated glomerular filtration rate declined by 8.5% (interquartile rate [IQR] −16.22% to −1.39%) (−3.50 mL/min/1.73 m2 IQR −8.00 to −1.00) vs 0% (−4.92%, 4.76%) in low dd-cfDNA patients (P =.004), de novo donor-specific antibody formation was seen in 40% (17/42) vs 2.7% (P <.0001), and future or persistent rejection occurred in 9 of 42 patients (21.4%) vs 0% (P =.003). The use of dd-cfDNA may complement the Banff classification and to risk stratify patients with borderline/TCMR 1A identified on biopsy. Copyright 2020 The Authors.en_US
dc.description.urihttps://doi.org/10.1111/ajt.15822en_US
dc.language.isoen_USen_US
dc.publisherBlackwell Publishing Ltden_US
dc.relation.ispartofAmerican Journal of Transplantation
dc.subjectbiomarkeren_US
dc.subjectcellular transplantation (non-islet)en_US
dc.subjectclinical research/practiceen_US
dc.subjectkidney (allograft) function/dysfunctionen_US
dc.subjectkidney failure/injuryen_US
dc.subjectmonitoring: immuneen_US
dc.subjectrejection: T cell mediated (TCMR)en_US
dc.titleHigh levels of dd-cfDNA identify patients with TCMR 1A and borderline allograft rejection at elevated risk of graft injuryen_US
dc.typeArticleen_US
dc.identifier.doi10.1111/ajt.15822
dc.identifier.pmid32056331


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