{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T02:13:53Z","timestamp":1769134433172,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA) serves as a monitoring tool for rejection, few studies have examined its utility in guiding immunosuppression management. Here, we present the largest kidney transplant population in which immunosuppression minimization and subsequent surveillance were guided by dd\u2010cfDNA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case series evaluated our immunosuppression minimization practice to tacrolimus and prednisone in kidney transplant recipients (KTR) from November 20, 2020, to September 26, 2024. Baseline dd\u2010cfDNA \u2264\u20090.5% was required before minimization. Immune tolerance was defined by the absence of any immune event after minimization: absolute dd\u2010cfDNA &gt;\u20090.5%, relative change value (RCV) &gt;\u200960% from baseline, biopsy\u2010proven acute rejection (BPAR), or de novo donor\u2010specific antibody (DSA). All other KTR were labeled intolerant. The primary endpoint was the rate of immune tolerance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Immunosuppression was modified to tacrolimus and prednisone in 38 KTR at a median of 223\u2009days post\u2010transplant. Most KTR were older adults at low immunological risk: mean of 69\u2009years and all had a calculated panel reactive antibody of 0%. 21 (55.3%) KTR met the primary end point of tolerance. The remaining 17 KTR were labeled intolerant secondary to dd\u2010cfDNA elevations including absolute &gt;\u20090.5% or RCV &gt;\u200960% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916 of 17, 94%), de novo DSA (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092 of 17, 11.8%), and\/or BPAR (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094 of 17, 23.5%). Although not statistically significant, intolerant KTR were numerically more likely to have 5\u20136 HLA mismatches (82.5% vs. 52.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.31), less likely to have thymoglobulin induction (29.4% vs. 42.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.39), and were minimized earlier after transplant (196 vs. 256\u2009days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.08) compared with tolerant KTR, respectively. Intervention after dd\u2010cfDNA elevations included immunosuppression increase (50%), additional dd\u2010cfDNA monitoring (81.3%), DSA testing (50%), and allograft biopsy (18.7%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Approximately 50% of low immunological risk KTR with a baseline dd\u2010cfDNA &lt;\u20090.5% tolerated immunosuppression minimization to tacrolimus and prednisone without concerning dd\u2010cfDNA elevations, BPAR, or DSA. Our study highlights the role of dd\u2010cfDNA as part of the armamentarium for identifying minimization candidates and performing subsequent surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70102","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T09:45:58Z","timestamp":1769075158000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Utilization of dd\u2010cfDNA Monitoring to Facilitate Immunosuppression Minimization After Kidney Transplantation in a U.S. Veteran Population"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5081-4649","authenticated-orcid":false,"given":"Laura","family":"Cotiguala","sequence":"first","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6328-7483","authenticated-orcid":false,"given":"Anne","family":"Przybylski","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0468-8271","authenticated-orcid":false,"given":"Cara","family":"Joyce","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"},{"name":"Loyola University Medical Center  Maywood Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0726-8695","authenticated-orcid":false,"given":"Gabrielle","family":"Hansen","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Shah","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8467-2300","authenticated-orcid":false,"given":"Reynold I.","family":"Lopez\u2010Soler","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital  Hines Illinois USA"},{"name":"Loyola University Medical Center  Maywood Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2007.02101.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000146258.79425.04"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13102734"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00638.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2014121234"},{"key":"e_1_2_10_7_1","article-title":"Steroid Avoidance or Withdrawal for Kidney Transplant Recipients","volume":"8","author":"Haller M. 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O.Gaber \u201cA Novel Donor Derived Cell Free DNA (Prospera\u00ae) Approach to Immunosuppression Minimization in Elderly Kidney Transplant Recipients \u201dPoster Presented at: Cutting Edge of Transplantation; February 2025; Scottsdale AZ.","DOI":"10.1016\/j.ajt.2025.07.381"},{"key":"e_1_2_10_22_1","unstructured":"Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) \u201cOPTN\/SRTR 2023 Annual Data Report \u201dU.S. Department of Health and Human Services Health Resources and Services Administration (2025) accessed July 21 2025 https:\/\/srtr.transplant.hrsa.gov\/annualdatareports."},{"key":"e_1_2_10_23_1","unstructured":"\u201cMYFORTIC [Package Insert] \u201d(East Hanover NJ: Novartis Pharmaceuticals Corporation) (2025)."},{"issue":"6","key":"e_1_2_10_24_1","first-page":"S778","article-title":"The Impact of Immunosuppression Adjustments on Dd\u2010cfDNA: Results of a Prospective Observational Surveillance Study in Kidney Transplant","volume":"24","author":"Markley S.","year":"2024","journal-title":"American Journal of Transplantation"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70102","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/phar.70102","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:17:18Z","timestamp":1769080638000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.70102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/phar.70102"],"URL":"https:\/\/doi.org\/10.1002\/phar.70102","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-09-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70102"}}