Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Nov 28, 2020; 10(11): 307-319
Published online Nov 28, 2020. doi: 10.5500/wjt.v10.i11.307
Donor-specific cell-free DNA as a biomarker in liver transplantation: A review
Tess McClure, Su Kah Goh, Daniel Cox, Vijayaragavan Muralidharan, Alexander Dobrovic, Adam G Testro
Tess McClure, Adam G Testro, Liver Transplant Unit, Austin Health, Heidelberg 3084, VIC, Australia
Su Kah Goh, Daniel Cox, Vijayaragavan Muralidharan, Department of Surgery, Austin Health, Heidelberg 3084, VIC, Australia
Alexander Dobrovic, Department of Surgery, The University of Melbourne, Heidelberg 3084, VIC, Australia
Author contributions: McClure T and Goh SK wrote the paper; Cox D, Muralidharan V, Dobrovic A and Testro AG edited the manuscript; all authors approved of the final version agree to be accountable for its contents.
Supported by The University of Melbourne, Parkville 3000, VIC, Australia
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tess McClure, FRACP, MBBS, Gastroenterologist and Hepatologist, PhD candidate, Liver Transplant Unit, Austin Health, 145 Studley Rd, Heidelberg 3084, VIC, Australia. tess.mcclure@austin.org.au
Received: August 2, 2020
Peer-review started: August 2, 2020
First decision: September 17, 2020
Revised: October 9, 2020
Accepted: October 30, 2020
Article in press: October 30, 2020
Published online: November 28, 2020
Processing time: 113 Days and 3 Hours
Abstract

Due to advances in modern medicine, liver transplantation has revolutionised the prognosis of many previously incurable liver diseases. This progress has largely been due to advances in immunosuppressant therapy. However, despite the judicious use of immunosuppression, many liver transplant recipients still experience complications such as rejection, which necessitates diagnosis via invasive liver biopsy. There is a clear need for novel, minimally-invasive tests to optimise immunosuppression and improve patient outcomes. An emerging biomarker in this ‘‘precision medicine’‘ liver transplantation field is that of donor-specific cell free DNA. In this review, we detail the background and methods of detecting this biomarker, examine its utility in liver transplantation and discuss future research directions that may be most impactful.

Keywords: Biomarkers; Precision medicine; Donor-specific cell-free DNA; Liver transplantation; Rejection; Review

Core Tip: Donor-specific cell-free DNA is a biomarker with promising clinical utility in liver transplantation. It demonstrates stereotypic dynamics in states of graft health, and is an early and accurate marker of acute rejection. This has been demonstrated in other solid-organ transplantations, where certain assays have progressed to commercialisation. Further studies examining donor-specific cell free DNA in liver transplantation, such as a randomised controlled trial or in combination with other assays, will assist with its translation into clinical practice. Ultimately, this emerging biomarker will need to be used in an integrated manner by experienced clinicians so as to improve patient outcomes.