Mr George Nita, a General Surgery Registrar and doctoral candidate in Bioinformatics at the University of Liverpool, is investigating how a simple blood test could improve how we detect rejection in kidney transplant patients—before the damage is done.
He recently received the Kidney Research UK Professor Michael Nicholson Transplant Surgeon Doctoral Fellowship, prestigious award and a grant of nearly £100,000 that will help support this pioneering work over the next 12 months. His research seeks to bring a new biomarker into clinical practice —donor-derived cell-free DNA (dd-cfDNA)—as an early warning signal of transplant rejection, potentially transforming post-transplant care.
Why this research matters
In the UK, more than 3,000 kidney transplants take place each year. While life-changing, these transplants come with a risk: the body may still recognise the new kidney as foreign and launch an immune attack—known as rejection. Despite significant advances in immunosuppressive therapy, around 1 in 5 patients will lose their transplant within five years. Rejection, especially when antibody-driven, is a silent but serious threat.
Currently, our monitoring relies on creatinine levels in the blood. This test is over 100 years old. By the time creatinine rises, damage may already be done. We are missing an important window of opportunity to treat rejection.
Confirming rejection usually requires a kidney biopsy—an invasive, expensive, and not risk-free procedure that can cause pain, bleeding, or even graft loss. Sometimes we have to act blindly—treating rejection without definitive proof—because getting answers can take weeks. I wouldn’t want this for my family, and I don’t want it for my patients. It’s important that we do better.
The science behind the solution
When transplanted kidney cells are injured, they release small fragments of their DNA pertaining to the donor into the recipient’s bloodstream. My research aims to measure this donor-derived cell-free DNA (dd-cfDNA) using a new technique called INDELs-based next-generation sequencing (NGS).
This approach offers unique advantages. Unlike other tests, which may struggle to differentiate between DNA from multiple previous donors and organs in patients who have had more than one transplant, this INDELs-based technology can distinguish genetic fingerprints with greater precision by screening the genomic DNA of both the recipient and donor/s. This makes it particularly useful in those patients who have had more than one transplant—and who are also the most likely to benefit from earlier detection.
Working closely with the Liverpool Clinical Laboratories and the University’s Centre for Genomic Research, I have tested this workflow in high-risk patients, and plan to expand this to a larger cohort. My early data suggests the test can pick up signs of rejection, drug toxicity, or antibody formation—well before conventional blood tests.
Beyond the blood test: using AI to personalise care
My study is part of the wider HLA-AB Study I lead, a prospective cohort study involving over 250 kidney transplant patients. Beyond dd-cfDNA, it includes monitoring donor-specific antibodies (DSAs)—key drivers of rejection—and uses machine learning to identify patterns that predict who is most at risk.
This, I hope, will enable clinicians to move from a “one-size-fits-all” approach to a tailored, risk-stratified strategy: We want to personalise monitoring—maybe some patients need frequent testing, while others might not need a biopsy at all. AI can help us get there.
My study also investigates how age impacts rejection risk. Since a 2019 change to the UK’s kidney allocation scheme, older recipients are more likely to receive poorer quality, higher-risk donor organs. I am exploring whether current immunosuppressive regimens are appropriate—or whether they need to be adapted to reduce side effects in older patients.
A patient-driven project
What sets my research apart is its grounding in patient priorities. Through surveys conducted via Kidney Care UK and the Cheshire and Merseyside Kidney Information Network (CamKIN), over 90% of patients expressed a desire for research to focus on preventing rejection and prolonging graft survival. Many said they would willingly participate in studies that could improve outcomes.
This project was led by our patients. Their voices were clear: we need better ways to detect rejection and make kidneys last longer. That’s exactly what I’m trying to do.
On the path to becoming a surgeon-scientist
My journey into research began alongside my surgical training. After completing an MSc in Surgical Sciences at the University of Edinburgh, where I earned a Distinction for my thesis on using kidneys from donors with acute kidney injury, I knew I wanted to pursue academic surgery.
I have since presented nationally and internationally and won multiple awards for my research, culminating with the award of the prestigious national Professor Michael Nicholson Transplant Surgeon PhD Fellowship in March 2025.
I love surgery, and I also love data and discovery. Being a surgeon-scientist gives me the chance to do both—to take what I see in the laboratory and bring it into clinical practice, at the bedside and into the operating theatres, translating it into something that can improve patient care on a wider scale.
The future
With support from Kidney Research UK and The Stoneygate Trust, Kidney Research Northwest, the University of Liverpool and Liverpool Clinical Laboratories, I am expanding the study to more patients and planning collaborations across the UK. My ultimate goal? To see dd-cfDNA testing adopted into routine transplant care, avoiding unnecessary biopsies and saving more kidneys.
Ten years ago, a lot of the technology we talked about in surgery and transplant seemed like science fiction. But today, it’s within reach. We just have to be bold enough to make it happen.