Document Type

Conference Proceeding

Publication Date


Publication Title

Archives of Pathology & Laboratory Medicine


Context: Noninvasive serum test for donor-derived cell-free DNA (dd-cfDNA) has been found useful for monitoring acute cellular rejection (ACR) and antibody-mediated rejection (AMR) since 2018, and the accepted threshold to indicate rejection is 1%. The goal of this pilot study was to determine if this test can correlate with renal biopsy results during a 1-year period when the dd-cfDNA test was initiated in our medical center.

Design: Renal transplant biopsies were evaluated for various rejection and nonrejection etiologies. Their corresponding dd-cfDNA percentages were identified. The biopsy data and dd-cfDNA results were correlated.

Results: During a year, we noticed a trend of gradual decline in renal transplant biopsies in our medical center, most likely due to available dd-cfDNA testing. We identified 10 renal transplant biopsies that had corresponding results of dd-cfDNA (Table). Two acute tubular necrosis (ATN) cases, one with borderline changes and one AA amyloidosis case, had normal percentage of dd-cfDNA. Only 1 nonrejection case with 1.2% dd-cfDNA showed IgG-κ proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) and scattered germinal centers. By contrast, 2 of 3 cases (66%) with mild (grade Ia) ACR showed dd-cfDNA more than 1%, while 2 AMR cases both also showed dd-cfDNA at >1%.

Conclusions: Our preliminary data, with good correlation between rejection and high percentage of dd-cfDNA, support the notion that the dd-cfDNA test is a valuable test to monitor both ACR and AMR.





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College of American Pathologists 2023 Annual Meeting CAP23, October 7-10, 2023, Chicago IL