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dc.contributor.authorBu, Lihong
dc.contributor.authorGupta, Gaurav
dc.contributor.authorPai, Akshta
dc.contributor.authorAnand, Sanjiv
dc.contributor.authorStites, Erik
dc.contributor.authorMoinuddin, Irfan
dc.contributor.authorBowers, Victor
dc.contributor.authorJain, Pranjal
dc.contributor.authorAxelrod, David A
dc.contributor.authorWeir, Matthew R
dc.contributor.authorWolf-Doty, Theresa K
dc.contributor.authorZeng, Jijiao
dc.contributor.authorTian, Wenlan
dc.contributor.authorQu, Kunbin
dc.contributor.authorWoodward, Robert
dc.contributor.authorDholakia, Sham
dc.contributor.authorDe Golovine, Aleskandra
dc.contributor.authorBromberg, Jonathan S
dc.contributor.authorMurad, Haris
dc.contributor.authorAlhamad, Tarek
dc.date.accessioned2022-02-28T14:42:22Z
dc.date.available2022-02-28T14:42:22Z
dc.date.issued2021-12-22
dc.identifier.urihttp://hdl.handle.net/10713/18111
dc.description.abstractThe use of routine monitoring of donor-derived cell-free DNA (dd-cfDNA) after kidney transplant may allow clinicians to identify subclinical allograft injury and intervene prior to development of clinically evident graft injury. To evaluate this, data from 1092 kidney transplant recipients monitored for dd-cfDNA over a three-year period was analyzed to assess the association of dd-cfDNA with histologic evidence of allograft rejection. Elevation of dd-cfDNA (0.5% or more) was significantly correlated with clinical and subclinical allograft rejection. dd-cfDNA values of 0.5% or more were associated with a nearly three-fold increase in risk development of de novo donor-specific antibodies (hazard ratio 2.71) and were determined to be elevated a median of 91 days (interquartile range of 30-125 days) ahead of donor specific antibody identification. Persistently elevated dd-cfDNA (more than one result above the 0.5% threshold) predicted over a 25% decline in the estimated glomerular filtration rate over three years (hazard ratio 1.97). Therefore, routine monitoring of dd-cfDNA allowed early identification of clinically important graft injury. Biomarker monitoring complemented histology and traditional laboratory surveillance strategies as a prognostic marker and risk-stratification tool post-transplant. Thus, persistently low dd-cfDNA levels may accurately identify allograft quiescence or absence of injury, paving the way for personalization of immunosuppression trials.en_US
dc.description.urihttps://doi.org/10.1016/j.kint.2021.11.034en_US
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.ispartofKidney Internationalen_US
dc.rightsCopyright © 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.en_US
dc.subjectallograft injuryen_US
dc.subjectallograft quiescenceen_US
dc.subjectbiomarkeren_US
dc.subjectdonor-derived cell-free DNAen_US
dc.subjectkidney transplanten_US
dc.subjectrejection surveillanceen_US
dc.titleClinical outcomes from the Assessing Donor-derived cell-free DNA Monitoring Insights of kidney Allografts with Longitudinal surveillance (ADMIRAL) study.en_US
dc.typeArticleen_US
dc.identifier.doi10.1016/j.kint.2021.11.034
dc.identifier.pmid34953773
dc.source.journaltitleKidney international
dc.source.countryUnited States


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