Expanding the non-invasive diagnosis of acute rejection in kidney transplants through detection of donor-derived DNA in Urine: Proof-of-concept study

Jieun Kim, Dong Moung Kim, Yu Jin Park, Seung Tae Lee, Hyon Suk Kim, Myoung Soo Kim, Beom Seok Kim, Jong Rak Choi

Research output: Contribution to journalArticlepeer-review


Background: Approximately 10%-20% of kidney transplant (KT) recipients suffer from acute rejection (AR); thus, sensitive and accurate monitoring of allograft status is recommended. We evaluated the clinical utility of donor-derived DNA (dd-DNA) detection in the urine of KT recipients as a non-invasive means for diagnosing AR. Methods: Urine samples serially collected from 39 KT recipients were tested for 39 single-nucleotide variant loci selected according to technical criteria (i.e., high minor allele frequency and low analytical error) using next-generation sequencing. The fraction of dd-DNA was calculated and normalized by the urine creatinine (UCr) level (%dd-DNA/UCr). The diagnostic performance of %dd-DNA/UCr for AR was assessed by ROC curve analysis. Results: There was an increasing trend of %dd-DNA/UCr in the AR group before subsequent graft injury, which occurred before (median of 52 days) histological rejection. The serum creatinine (SCr) level differed significantly between the AR and non-AR groups at two and four months of follow-up, whereas %dd-DNA/UCr differed between the groups at six months of follow-up. The combination of %dd-DNA/UCr, SCr, and spot urine protein (UPtn)/UCr showed high discriminating power, with an area under the ROC curve of 0.93 (95% confidence interval: 0.81-1.00) and a high negative predictive value of 100.0%. Conclusions: Although the dd-DNA-based test cannot eliminate the need for biopsy, the high negative predictive value of this marker could increase the prebiopsy probability of detecting treatable injury to make biopsy an even more effective diagnostic tool.

Original languageEnglish
Pages (from-to)469-478
Number of pages10
JournalAnnals of laboratory medicine
Issue number5
Publication statusPublished - 2021 Sept

Bibliographical note

Funding Information:
Kim J participated in research design and in the writing of the paper. Kim DM participated in the performance of the research. Park YJ participated in the acquisition of data. Lee ST contributed provided technical and analytical support. Kim HS participated in advising research methodology. Kim MS participated in research design and collection of samples. Kim BS participated in critically revising the study. Choi JR supervised the full study and acquired financial support.

Publisher Copyright:
© Korean Society for Laboratory Medicine

All Science Journal Classification (ASJC) codes

  • Biochemistry, medical
  • Clinical Biochemistry


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