Diagnostic Accuracy of Donor-derived Cell-free DNA in Renal-allograft Rejection: A Meta-analysis

诊断优势比 诊断试验中的似然比 优势比 置信区间 接收机工作特性 胎儿游离DNA 荟萃分析 医学 诊断准确性 泌尿科 肾移植 移植 人口 胃肠病学 内科学 生物 遗传学 产前诊断 怀孕 胎儿 环境卫生
作者
Hanyu Xiao,Fang Gao,Qidan Pang,Qiuxiang Xia,Xianpeng Zeng,Jingtao Peng,Lei Fan,Jiali Liu,Zhendi Wang,Heng Li
出处
期刊:Transplantation [Wolters Kluwer]
卷期号:105 (6): 1303-1310 被引量:39
标识
DOI:10.1097/tp.0000000000003443
摘要

Background. Donor-derived cell-free DNA (dd-cfDNA) is a potential noninvasive molecular marker of graft rejection after kidney transplant, whose diagnostic accuracy remains controversial. Methods. We performed a systematic review and metaanalysis to evaluate the diagnostic accuracy of dd-cfDNA. Relevant literature was searched from online databases, and the data on the diagnostic accuracy of discriminating main rejection episodes (MRE) and antibody-mediated rejection (AMR) were merged, respectively. Results. Nine studies were included in the metaanalysis, of which 6 were focused on the diagnostic accuracy of dd-cfDNA for MRE, whose pooled sensitivity, specificity, area under the receiver operating characteristics curve, diagnostic odds ratio, overall positive likelihood ratio, and negative likelihood ratio with 95% confidence intervals were 0.70 (0.57-0.81), 0.78 (0.70-0.84), 0.81 (0.77-0.84), 8.18 (5.11-13.09), 3.15 (2.47-4.02), and 0.39 (0.27-0.55), respectively. Five tests were focused on discriminating AMR, whose pooled indicators were 0.84 (0.75-0.90), 0.80 (0.74-0.84), 0.89 (0.86-0.91), 20.48 (10.76-38.99), 4.13(3.21-5.33), and 0.20(0.12-0.33), respectively. Conclusions. Donor-derived cell-free DNA can be a helpful marker for the diagnosis of AMR among those recipients suspected of renal dysfunction. Its diagnostic accuracy on the MRE remains uncertain, which requires further prospective, large-scale, multicenter, and common population research.
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