TRANSPLANT MONITORING
6 Gielis EM, Ledeganck KJ, De Winter BY, et al. Cell-Free DNA: An Upcoming Biomarker in Transplantation. Am J Transplant. 2015;15(10):2541-2551. doi:10.1111/ajt.13387
7 Loy C, Ahmann L, De Vlaminck I, Gu W. Liquid Biopsy Based on Cell-Free DNA and RNA. Annu Rev Biomed Eng. 2024;26(1):169-195. doi:10.1146/annurev- bioeng-110222-111259
8 Mandel P, Metais P. Les acides nucléiques du plasma sanguin chez l’homme [Nuclear Acids In Human Blood Plasma]. C R Seances Soc Biol Fil. 1948;142(3-4):241-243.
The workflow in this pilot study includes the use of Promega’s new Maxwell RSC Rapid ccfDNA extraction kits, Maxwell RSC and Maxwell RSC 48 instruments.
detection of allograft rejection beyond standard of care patient monitoring.1,2 Dr Sarinder Day shares the opinion that transplant physicians would benefit from better immunosuppressive guidance and having an alternative when biopsies are refused or contraindicated. Overall, the introduction of dd- cfDNA testing into routine clinical practice represents a paradigm shift in transplant medicine moving away from reactive management based on late-stage functional decline, toward proactive surveillance. By enabling earlier detection of allograft rejection, cfDNA has the potential to transform patient care through more precise, personalised immunosuppression, fewer invasive procedures, and ultimately, improved long-term graft survival. The NBT pilot study marks an important step toward national adoption, offering real-world evidence that could inform future NICE guidelines and elevate the standard of care for kidney transplant recipients across the UK. As cfDNA technology continues to mature, its integration alongside next-generation HLA typing and other molecular diagnostics may usher in a new era of precision transplantation medicine – one where earlier intervention means longer, healthier lives for transplant patients.
Acknowledgement n Thanks to Dr Sarinder Day for her contributions to this article.
References 1 Aubert O, Ursule-Dufait C, Brousse R,
et al. Cell-free DNA for the detection of kidney allograft rejection. Nat Med. 2024;30(8):2320-2327. doi:10.1038/ s41591-024-03087-3
2 NHS Blood and Transplant. Annual report 2024/25. (
Gov.uk, 2025)
www.gov.uk/ government/publications/nhs-blood-and- transplant-annual-report-and-accounts- 2024-to-2025
3 Oellerich M, Budde K, Osmanodja B, et al. Donor-derived cell-free DNA as a diagnostic tool in transplantation. Front Genet. 2022;13:1031894. doi:10.3389/ fgene.2022.1031894
4 Nikolova A, Agbor-Enoh S, Bos S, et al. European Society for Organ Transplantation (ESOT) Consensus Statement on the Use of Non-invasive Biomarkers for Cardiothoracic Transplant Rejection Surveillance. Transpl Int. 2024;37:12445. doi:10.3389/ ti.2024.12445
5 Bloom RD, Bromberg JS, Poggio ED, et al. Cell-Free DNA and Active Rejection in Kidney Allografts. J Am Soc Nephrol. 2017;28(7):2221-2232. doi:10.1681/ ASN.2016091034
9 Lo YM, Tein MS, Pang CC, Yeung CK, Tong KL, Hjelm NM. Presence of donor-specific DNA in plasma of kidney and liver-transplant recipients. Lancet. 1998;351(9112):1329-1330. doi:10.1016/ s0140-6736(05)79055-3
10 Greytak SR, Engel KB, Parpart-Li S, et al. Harmonizing Cell-Free DNA Collection and Processing Practices through Evidence-Based Guidance. Clin Cancer Res. 2020;26(13):3104-3109. doi:10.1158/
1078-0432.CCR-19-3015
11 Khush KK, Patel J, Pinney S, et al. Noninvasive detection of graft injury after heart transplant using donor- derived cell-free DNA: A prospective multicenter study. Am J Transplant. 2019;19(10):2889-2899. doi:10.1111/ ajt.15339
12 Park S, Sellares J, Tinel C, Anglicheau D, Bestard O, Friedewald JJ. European Society of Organ Transplantation Consensus Statement on Testing for Non- Invasive Diagnosis of Kidney Allograft Rejection. Transpl Int. 2024;36:12115. doi:10.3389/ti.2023.12115
13 Edwards RL, Menteer J, Lestz RM, Baxter-Lowe LA. Cell-free DNA as a solid-organ transplant biomarker: technologies and approaches. Biomark Med. 2022;16(5):401-415. doi:10.2217/ bmm-2021-0968
14 Pagliazzi A, Bestard O, Naesens M. Donor-Derived Cell-Free DNA: Attractive Biomarker Seeks a Context of Use. Transpl Int. 2023;36:12406. doi:10.3389/ti.2023.12406
This article was written by Dr Stephanie Anderson in conjunction with Dr Sarinder Day.
Whilst the utility of dd-cfDNA as a marker of rejection has been firmly established in heart, kidney, liver, lung, and other transplants it has yet to be established in UK clinical settings
48
Dr Sarinder Day is the lead clinical scientist in immunogenetics at the NHSBT H&I laboratory in Bristol. Dr Stephanie Anderson is Product Manager for Genomics and High Throughput at Promega UK.
Promega UK
+(44) 23 8076 0225
ukcustserve@promega.com
www.promega.co.uk
OCTOBER 2025
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