Assessing transplant complication risk with total cell-free dna

Abstract

This invention relates to methods and compositions for assessing an amount of total cell-free DNA, such as from a transplant subject. The methods and composition provided herein can be used to determine risk of complications following transplantation, including infection, cardiac arrest, and death, in a subject.

1 . A method of assessing a sample from a transplant subject, the method comprising:
 (a) determining an amount of total cf-DNA in a sample from the subject, wherein the subject has, is suspected of having, has had, or is at risk of having a transplant complication; and   (b) reporting and/or recording the amount of total cf-DNA.   
     
     
         2 . The method of  claim 1 , wherein the method further comprises:
 (c) comparing the amount of total cf-DNA to a threshold total cf-DNA value or at least one prior total cf-DNA amount.   
     
     
         3 . The method of  claim 1 , wherein the method further comprises:
 (d) determining that the subject has, or as being at increased risk of having, a transplant complication based on the determined amount of total cf-DNA compared to the threshold total cf-DNA value and/or at least one prior total cf-DNA amount.   
     
     
         4 . A method of assessing a transplant subject, the method comprising:
 (a) obtaining an amount of total cf-DNA in a sample from the subject, wherein the subject has, is suspected of having, has had, or is at risk of having a transplant complication;   (b) comparing the amount of total cf-DNA to a threshold total cf-DNA value and/or at least one prior total cf-DNA amount; and   (c) determining a treatment or monitoring regimen for the subject based on the determined amount of total cf-DNA compared to the threshold total cf-DNA value and/or at least one prior total cf-DNA amount.   
     
     
         5 . The method of  claim 4 , wherein the method further comprises classifying the subject as having or as being at increased risk of having a transplant complication based on the determined amount of total cf-DNA compared to the threshold total cf-DNA value and/or at least one prior total cf-DNA amount. 
     
     
         6 . The method of  claim 1 , wherein the subject is on or is in need of mechanical support. 
     
     
         7 . The method of  claim 1 , wherein the subject has been determined to have a transplant complication. 
     
     
         8 . The method of  claim 1 , wherein the subject was determined to have the transplant complication with one or more additional test(s) prior applied to the subject or the method further comprises performing one or more additional test(s) on the subject. 
     
     
         9 - 14 . (canceled) 
     
     
         15 . The method of  claim 1 , wherein the amount of total cf-DNA is determined or obtained by:
 (a) for a plurality of single nucleotide variant (SNV) targets, performing an amplification-based quantification assay, such as a polymerase chain reaction (PCR) quantification assay, on the sample, or a portion thereof, with at least two primer pairs, wherein each primer pair comprises a forward primer and a reverse primer, wherein one of the at least two primer pairs comprises a 3′ penultimate mismatch in a primer relative to one allele of the SNV target, but a 3′ double mismatch relative to another allele of the SNV target and specifically amplifies the one allele of the SNV target, and another of the at least two primer pairs specifically amplifies to another allele of the SNV target, and (b) assessing the amount of total cf-DNA based on the results.   
     
     
         16 . The method of  claim 15 , wherein the genotype of the donor is known or unknown. 
     
     
         17 . (canceled) 
     
     
         18 . The method of  claim 1 , wherein the amount of total cf-DNA is determined or obtained using an amplification-based quantification assay. 
     
     
         19 - 20 . (canceled) 
     
     
         21 . The method of  claim 1 , wherein an amount of total cf-DNA of 8 or 9 ng/mL or greater represents a risk of cardiac arrest or death. 
     
     
         22 . The method of  claim 1 , wherein an amount of total cf-DNA of 20 ng/mL or greater represents the presence of an infection or an increased risk of infection. 
     
     
         23 . The method of  claim 1 , wherein at least one amount is determined in a sample taken from the subject within 4, 5, 6, 7, or 8 days following an organ transplant. 
     
     
         24 . The method of  claim 1 , wherein an amount of total cf-DNA that is greater than the threshold value and/or is increased relative to the amount from an earlier time point represents an increased or increasing risk, or wherein an amount of total cf-DNA that is lower than the threshold value and/or is decreased relative to the amount from an earlier time point represents a decreased or decreasing risk. 
     
     
         25 . (canceled) 
     
     
         26 . The method of  claim 4 , wherein the determining a monitoring regimen comprises determining the amount of total cf-DNA in the subject over time or at a subsequent point in time, suggesting such monitoring to the subject, or using or suggesting the use of one or more additional test(s) to assess the subject. 
     
     
         27 - 33 . (canceled) 
     
     
         34 . The method of  claim 4 , wherein the determining a treatment regimen comprises selecting or suggesting a treatment for the subject suggesting a treatment for the subject, treating the subject, or providing information about treatment to the subject. 
     
     
         35 - 37 . (canceled) 
     
     
         38 . The method of  claim 4 , wherein the treatment is an anti-infection treatment, an anti-rejection treatment, or a cardiac arrest treatment. 
     
     
         39 - 40 . (canceled) 
     
     
         41 . The method of  claim 1 , wherein the sample is a blood, plasma or serum sample. 
     
     
         42 . (canceled) 
     
     
         43 . The method of  claim 1 , wherein the transplant subject is a heart transplant subject.