{"id":1906,"date":"2022-10-21T15:00:29","date_gmt":"2022-10-21T07:00:29","guid":{"rendered":"https:\/\/transnovo.com\/news\/%e7%ac%ac%e4%ba%8c%e5%b1%8agcfdna%e4%b8%93%e5%ae%b6%e9%a1%be%e9%97%ae%e7%a0%94%e8%ae%a8%e4%bc%9a%e9%a1%ba%e5%88%a9%e5%8f%ac%e5%bc%80%ef%bc%9a%e7%9b%91%e6%b5%8b%e8%82%be%e6%8d%9f%e4%bc%a4%ef%bc%8c\/"},"modified":"2023-06-02T15:11:03","modified_gmt":"2023-06-02T07:11:03","slug":"%e7%ac%ac%e4%ba%8c%e5%b1%8agcfdna%e4%b8%93%e5%ae%b6%e9%a1%be%e9%97%ae%e7%a0%94%e8%ae%a8%e4%bc%9a%e9%a1%ba%e5%88%a9%e5%8f%ac%e5%bc%80%ef%bc%9a%e7%9b%91%e6%b5%8b%e8%82%be%e6%8d%9f%e4%bc%a4%ef%bc%8c","status":"publish","type":"post","link":"https:\/\/transnovo.com\/en\/news\/%e7%ac%ac%e4%ba%8c%e5%b1%8agcfdna%e4%b8%93%e5%ae%b6%e9%a1%be%e9%97%ae%e7%a0%94%e8%ae%a8%e4%bc%9a%e9%a1%ba%e5%88%a9%e5%8f%ac%e5%bc%80%ef%bc%9a%e7%9b%91%e6%b5%8b%e8%82%be%e6%8d%9f%e4%bc%a4%ef%bc%8c\/","title":{"rendered":"The 2nd GcfDNA Expert Advisor Workshop was successfully held: Monitoring Kidney Injury, Early Warning ABMR"},"content":{"rendered":"
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Preface<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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September 29, 2022, organized by Health Farming Medicine\"The 2nd GcfDNA Expert Advisor Workshop\"<\/strong><\/span>It was successfully held online as scheduled. Several experts in the field of transplantation gathered online to discuss the clinical application of GcfDNA dynamic monitoring technology in the post-transplantation period for high-risk patients with ABMR, and other exciting contents!<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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The seminar invited the Third Xiangya Hospital of Central South UniversityProf. Yingzhi Ming<\/span><\/strong>and Shulan (Hangzhou) HospitalProf. Zhangfei Shou<\/span><\/strong>Co-chair of the conference, Sichuan Provincial People's HospitalProf. Wei Liang<\/span><\/strong>and Changhai Hospital of Naval Medical UniversityProf. Lei Zhang<\/span><\/strong>To share the topic, and invited to the First Hospital of China Medical UniversityProf. Ying Cheng<\/span><\/strong>Beijing Friendship Hospital, Capital Medical UniversityProf. Yichen Zhu<\/span><\/strong>We have been working with experts in clinical issues such as<\/p>\n

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Opening Address<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Rejection reactions are an important problem that may be present in patients after transplantation. How is rejection diagnosed? Pathological puncture is the \"gold standard\", but it is not accepted by all transplant patients, and because it is not easy to perform, it still needs continuous improvement.<\/p>\n

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Prof. Yingzhi Ming<\/span><\/strong>In his speech, he said that minimally invasive\/non-invasive diagnostic techniques are gradually starting to be promoted internationally, and cfDNA, as one of the hot spots, also plays an important role in the field of transplantation. Organ transplantation requires intervention in the donor's organ, which inevitably brings in another set of genes and releases them into the recipient under different circumstances. Early warning ABMR is a good direction to detect kidney injury by detecting free DNA from apoptotic or necrotic donor cells in circulating body fluids.<\/p>\n

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Prof. Zhangfei Shou<\/span><\/strong>As mentioned, GcfDNA is a hot topic in the field of transplantation, and in this expert workshop, we will discuss in depth how it can be applied to the clinic and serve transplant patients.<\/p>\n

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Academic Seminars<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Prof. Wei Liang<\/span><\/strong>Delivered a keynote reportAdjunctive Diagnosis of Rejection after Organ Transplantation - Application of Donor Source Free Nucleic Acid (GcfDNA) Technology<\/span><\/strong>To kick off this academic sharing. Since 2017, the research of blood GcfDNA in the field of organ transplantation began to increase year by year, with kidney transplantation as the main representative.<\/p>\n

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The International Journal of Nephrology previously published this year a longitudinal surveillance study from a large US multicenter involving 1092 kidney transplant recipients and 219 paired biopsies to assess the effectiveness of GcfDNA in identifying rejection after transplantation. The final selection was 203 patients and 219 sets of paired GcfDNA results with <30 days between GcfDNA results and tissue biopsy results. The results showed that:<\/p>\n

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  • Compared to creatinine, GcfDNA had a better differentiation between rejection and non-rejection reactions. (GcfDNA, median value in rejection group vs median value in non-rejection group: 1.60% vs 0.23%)<\/li>\n
  • GcfDNA can further distinguish between different types of rejection reactions such as ABMR and TCMR.(GcfDNA%: median value 1.8% in ABMR group, median value 0.7% in TCMR, median value 0.23% in non-rejection group)<\/li>\n
  • GcfDNA% was higher in samples biopsied for abnormal clinical indicators relative to routine biopsy samples.<\/li>\n
  • The risk of rejection increased 3.3-fold for every 1% rise in GcfDNA%.<\/li>\n<\/ul>\n

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    Due to individual differences in GcfDNA levels between graft and recipientTherefore, long-term dynamic monitoring of GcfDNA is more recommended in clinical practice<\/span><\/strong>. Several universities and medical centers in the U.S. recommend GcfDNA testing once in January, February, March, April, June, September, and December for 1 year after surgery as a post-transplant immune conversion point to assist physicians in clinical decision making.<\/p>\n

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    It has been pointed out in the literature that 2 consecutive GcfDNA% tests with an increase up to 61% are beyond the biological floating interval of dd-cfDNA and need to increase the frequency of testing; when the increase reaches 149%, it has entered the high-risk rejection interval and biopsy puncture verification is recommended for timely intervention.<\/p>\n

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    How can GcfDNA metrics be better applied to post-transplant health management?<\/span><\/strong><\/p>\n

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    Professor Wei Liang made four points:<\/p>\n

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    1. Stable technology system<\/li>\n
    2. Establishing an individualized GcfDNA baseline<\/li>\n
    3. Dynamic monitoring of the trend and magnitude of GcfDNA changes<\/li>\n
    4. Integration of other clinical indicators<\/li>\n<\/ol>\n

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      Prof. Lei Zhang<\/span><\/strong>InClinical Implications of GcfDNA Monitoring for Patients at High Risk of AMR<\/span><\/strong>It was mentioned that antibody-mediated rejection (AMR) is the main cause of long-term survival of the transplanted kidney and the primary cause of transplant kidney loss. Among them, dnDSA is the main cause of AMR in non-sensitized patients, and AMR three months after transplantation is also dominated by dnDSA.<\/p>\n

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      A high donor-recipient HLA mismatch load leads to an increased risk of dnDSA, but there are still clinical difficulties in properly assessing donor-recipient HLA mismatch load.<\/p>\n

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      Professor Lei Zhang said that AMR is clinically difficult to diagnose, and still relies mainly on DSA determination and pathological puncture, which is not timely and limited by various factors. Also the treatment of AMR has certain difficulties, with poor results and expensive costs. To date, no uniform protocol has been developed for the treatment of caAMR. Therefore, early diagnosis and aggressive treatment are crucial to save the transplanted kidney.<\/p>\n

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      Early detection of DSA by regular and periodic DSA testing after transplantation is essential to predict the occurrence of AMR in recipients. However, at the same time, DSA still has some limitations in warning AMR, with missed and false positives in detection, and no uniform threshold criteria for positive clinical diagnosis. At the same time, it still takes some time from positive DSA to pathological damage of AMR, and DSA does not necessarily cause AMR.<\/p>\n

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      GcfDNA, as an important and sensitive early marker of organ damage, can be a good adjunct to DSA to make up for its shortcomings and diagnose AMR as early as possible<\/span><\/strong>. Data from several studies show that:<\/p>\n

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      • Elevated GcfDNA is accompanied by increased risk of dnDSAs production<\/li>\n
      • GcfDNA assists in the diagnosis of rejection with better performance response than creatinine<\/li>\n
      • GcfDNA can give feedback on graft damage and cross-indicate with DSA to compensate for the shortcomings of DSA.\n

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        Expert Discussion<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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        Afterwards, the experts discussed the following three topics in depth, and all of them expressed their views from the clinical point of view.<\/p>\n

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        Prof. Yichen Zhu<\/strong>indicates that our hospital has also gradually introduced GcfDNA testing, and that the main constraint is still economic. For third-party testing, the cost is still at a medium to high level and is not accepted by all patients. In the future, we need to consider how to expand GcfDNA technology to more areas and explore greater value, such as combined diagnosis with DSA.<\/p>\n

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        Meanwhile, most of the studies on GcfDNA have been conducted abroad, and there is still a lack of data and reports on studies related to the Chinese population.<\/p>\n

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        Prof. Ying Cheng<\/strong>pointed out that in the field of transplantation, everyone is looking for a non-invasive and more sensitive, specific and earlier biomarker to determine the status of the kidney and monitor the occurrence of rejection. For the application of GcfDNA, Prof. Ying Cheng also threw out the question:Currently we are discussing more about GcfDNA in blood, what about GcfDNA in urine is there has a diagnostic value?<\/strong><\/span><\/section>\n

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        Professor Wei Liang added to this that there are already foreign studies conducted on blood and urine bound GcfDNA, but several challenges remain with urinary GcfDNA:<\/p>\n

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        1. Since urine is excreted through the kidneys, the level of GcfDNA in the urine is very high, even higher than the transplant patients' own cfDNA.<\/li>\n
        2. GcfDNA content is strongly influenced by urine concentration, and the values after fasting and drinking water have a certain difference.<\/li>\n
        3. The studies and techniques related to urinary GcfDNA, etc. are yet to be clarified.<\/li>\n<\/ol>\n

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          However, the above problem does not exist in liver transplantation, and the only source of GcfDNA in the urine of liver transplant patients is the transplanted liver, so Prof. Wei Liang is also conducting research related to liver urine GcfDNA with Sichuan Provincial People's Hospital.<\/section>\n

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          Prof. Yingzhi Ming and Prof. Zhangfei Shou conclude:<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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          GcfDNA technology has gained international recognition, but there is still a lack of data belonging to our country and each transplant center itself in China. In the next step, we hope to conduct a multicenter longitudinal study in conjunction with several transplant hospitals to lay the foundation for clinical application.<\/p>\n

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          Meanwhile, for the cost of GcfDNA, Prof. Shou Zhangfei believes that the price of GcfDNA is limited by the small number of users at present, and in the future, by expanding the application fieldWhenAs more transplant patients enjoy this technology, it is believed that the cost of GcfDNA will decrease accordingly.<\/span><\/span><\/p>\n

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          \"The 2nd GcfDNA Expert Advisor Workshop was successfully concluded with lively discussions. This meeting discussed in depth the clinical application of GcfDNA dynamic monitoring technology in AMR high-risk patients after transplantation, especially the significance of the detection of GcfDNA in combination with DSA.<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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          *This article is for medical related professionals only<\/span><\/p>\n

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          Scan the code to follow us<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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          Micro Signal\uff5cTx New Solution<\/p>\n

          Jianfeng Medicine, focus on transplant industry<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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           <\/p>","protected":false},"excerpt":{"rendered":"

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