供者来源性细胞游离DNA在肾移植诊疗中的研究进展与应用

Research progress and application of donor-derived cell-free DNA in diagnosis and treatment of kidney transplantation

肾移植术后排斥反应的早期诊断及治疗对于减少移植物损伤至关重要。供者来源性细胞游离DNA(dd-cfDNA)检测是基于二代测序等技术,通过浓度法及绝对定量法检测循环体液中源于坏死、凋亡的供肾组织DNA片段含量,具有监测同种异体移植物损伤的临床应用潜力。相比传统血清肌酐等检测指标,dd-cfDNA检测可提前数周至数月监测到移植物损伤,为临床治疗和延缓移植物失功提供了“时间窗”。随着近年来对ddcfDNA研究的不断深入,dd-cfDNA因其兼具无创性、灵敏度高和能够对治疗效果进行实时评估等特点受到广泛关注。本文综述了目前有关dd-cfDNA检测在肾移植诊疗中多维度应用的研究证据与结论,并讨论了dd-cfDNA未来的研究和临床应用方向,旨在为dd-cfDNA检测广泛应用于我国的临床实践提供参考依据。

Early diagnosis and treatment of rejection after kidney transplantation play a critical role in alleviating allograft injury.Detection of donor-derived cell-free DNA(dd-cfDNA)could be performed based on the next-generation sequencing and other techniques.The content of DNA fragments derived from necrotic and apoptotic donor kidney tissues in circulating body fluids could be determined by concentration and absolute quantitative methods,which has application potential in monitoring allograft injury in clinical practice.Compared with traditional serum creatinine and other indicators,dd-cfDNA detection may monitor allograft injury from several weeks to months in advance,providing a“time window”for clinical treatment and delaying graft failure.Along with deepening research of dd-cfDNA in recent years,dd-cfDNA has captivated widespread attention due to its non-invasiveness,high sensitivity and real-time evaluation of therapeutic effect.In this article,current study evidence and conclusions related to multidimensional application of ddcfDNA detection in diagnosis and treatment of kidney transplantation were reviewed,and the future research and clinical application direction of dd-cfDNA were discussed,aiming to provide reference for widespread application of dd-cfDNA detection in clinical practice in China.