肾移植中供体来源的游离DNA作为潜在的排斥生物标志物的研究进展

Research progress on donor-derived cell-free DNA as a potential rejection biomarker in kidney transplantation

摘要:

肾脏疾病已成为全球公共卫生问题。终末期肾病患者必须依靠透析或肾移植治疗，而肾移植是终末期肾病的最佳治疗方法。肾移植提高了患者生活质量，延长了患者生存时间，然而，由于免疫或非免疫因素导致一些患者移植物功能过早丧失，因此，并非所有患者都能从移植术中完全受益。循环游离DNA（cfDNA）是指存在于血液等体液中的小片段DNA，通常源自身体各个组织的细胞。供体来源的cfDNA（dd-cfDNA）是患者外源性且来自移植器官的cfDNA。与侵入性活检不同，dd-cfDNA可以通过对样本的非侵入性分析来检测。dd-cfDNA浓度可能在肌酐水平升高之前就增加了，这有助于早期诊断移植损伤和充分治疗，以避免移植物过早丢失。该文综述有关cfDNA在肾移植中的作用研究，希望为dd-cfDNA检测广泛应用于临床实践提供参考依据。

Abstract:

Kidney diseases have become a global public health issue. Patients with end-stage renal disease rely on dialysis or kidney transplantation for treatment, with kidney transplantation being the best option. Kidney transplantation improves the quality of life and prolongs survival, but some patients experience early graft loss due to immune or non-immune factors, meaning not all patients fully benefit from transplantation. Circulating free DNA (cfDNA) refers to small fragments of DNA found in bodily fluids such as blood, typically originating from various tissues. Donor-derived cfDNA (dd-cfDNA) is the exogenous cfDNA from the transplanted organ. Unlike invasive biopsy, dd-cfDNA can be detected through non-invasive analysis of samples. The concentration of dd-cfDNA may increase even before creatinine levels rise, assisting in the early diagnosis of graft injury and providing an opportunity for early intervention to prevent premature graft loss. This review summarizes research on the role of cfDNA in kidney transplantation and aims to provide a reference for the widespread clinical application of dd-cfDNA testing.