Association between dd-cfDNA levels, de novo donor specific antibodies, and eGFR decline: An analysis of the DART cohort.
Bernard V. Fischbach M.D.
Sawinski, D., Mehta, S., Alhamad, T., Bromberg, J.S., Fischbach, B., Aeschbacher, T., Ghosh, S., Shekhtman, G., Dholakia, S., Brennan, D.C., Poggio, E., Bloom, R. and Jordan, S.C. (2021). “Association between dd-cfDNA levels, de novo donor specific antibodies, and eGFR decline: An analysis of the DART cohort.” Clin Transplant Jun 28. [Epub ahead of print].
Despite advances in immunosuppression, long-term allograft survival remains a challenge and evidence of immune mediated injury can be detected even early in the posttransplant course. The emergence of de novo donor specific antibodies (dnDSA) is a particularly poor prognostic indicator; the detection of DSA is highly correlated with the development of antibody-mediated allograft injury and subsequent graft loss. A study from Wiebe et al. demonstrated that patients with dnDSA had markedly reduced 10-year allograft survival (57% versus 96%). One of the challenges in this population is the lack of consensus regarding therapeutic interventions for dnDSA, complicated by the fact that allograft dysfunction often progresses despite augmented immunosuppression. Particularly problematic is that long-lived plasma cells, the source of dnDSA, are generally resistant to maintenance immunosuppression, and therapies targeted towards them have significant side effects. [No abstract; excerpt from article].