Donor-derived cell-free DNA as a diagnostic marker for kidney-allograft rejection: a systematic review and meta-analysis-testni naslov

Abstract

Testni abstrakt - Donor-derived cell-free DNA (dd-cfDNA) is a promising biomarker for the detection of graft rejection. We evaluated the accuracy and clinical value of applying it to kidney transplant rejection. Relevant literature on dd-cfDNA diagnosis of kidney transplant rejection was searched in PubMed, Embase, Cochrane Library, and Web of Science databases from the time of construction to 2023. Data and study characteristics were extracted independently by two researchers, and disagreements were resolved by negotiation. We merged diagnostic accuracy data distinguishing major rejection (MRE) and antibody-mediated rejection (AMR) separately. Potential heterogeneity was analyzed by subgroup analysis or meta-regression. Funnel plots were used to clarify the presence or absence of publication bias. A total of 17 publications provided data on the accuracy of dd-cfDNA in diagnosing patients with MRE. The pooled sensitivity, specificity, and the area under the receiver operating characteristic curve with 95% confidence intervals (CI) were 0.60 (95% CI, 0.51-0.69), 0.85 (95% CI, 0.81-0.89), and 0.83 (95% CI, 0.79-0.86), respectively. Additionally, 12 studies focused on the diagnostic efficacy of dd-cfDNA for ABMR, showing pooled sensitivity, specificity, and the area under the receiver operating characteristic curve with 95% CI of 0.81 (95% CI, 0.72–0.88), 0.80 (95% CI, 0.73–0.86), and 0.87 (95% CI, 0.84-0.90), respectively. The type of study, age group, and sample size were responsible for the heterogeneity. In summary, Due to significant heterogeneity, the accuracy of Dd-cfDNA in diagnosing patients with MRE is not very reliable. However, Dd-cfDNA can serve as a biomarker for diagnosing ABMR.