{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:27:24Z","timestamp":1793831244832,"version":"4.6.1"},"reference-count":13,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T00:00:00Z","timestamp":1639699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Donor\u2010derived cell free DNA (dd\u2010cfDNA) has rapidly become part of rejection surveillance following orthotopic heart transplantation. However, some patients show elevated dd\u2010cfDNA without clinical evidence of rejection. With the aim to provide a clinical description of this subpopulation, we retrospectively analyzed 35 cardiac transplant recipients at our center who experienced elevated (\u2265.20%) dd\u2010cfDNA in the absence of clinical rejection, out of a total 106 recipients who had dd\u2010cfDNA results available during the first year. The median time to first elevated dd\u2010cfDNA level was 46 days, and the highest dd\u2010cfDNA recorded within 1 year was .31% [inter\u2010quartile range, .23\u2013.45]. Twenty\u2010two (63%) patients experienced infections (cytomegalovirus (CMV) or other), and 16 (46%) presented with <jats:italic>de novo<\/jats:italic> donor\u2010specific antibodies. Cluster analysis revealed four distinct groups characterized by <jats:italic>(a)<\/jats:italic> subclinical rejection with 50% CMV (<jats:italic>n<\/jats:italic>\u00a0=\u00a016), <jats:italic>(b)<\/jats:italic> non\u2010CMV infections and the longest time to first elevated dd\u2010cfDNA (187 days) (<jats:italic>n<\/jats:italic>\u00a0=\u00a08), <jats:italic>(c)<\/jats:italic> right ventricular dysfunction (<jats:italic>n<\/jats:italic>\u00a0=\u00a06), and <jats:italic>(d)<\/jats:italic> women who showed the youngest median age (45 years) and highest median dd\u2010cfDNA (.50%) (<jats:italic>n<\/jats:italic>\u00a0=\u00a05). Continued prospective analysis is needed to determine if these observations warrant changes in patient management to optimize the utilization of this vital non\u2010invasive graft surveillance tool.<\/jats:p>","DOI":"10.1111\/ctr.14549","type":"journal-article","created":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T13:39:15Z","timestamp":1638625155000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Observed elevated donor\u2010derived cell free DNA in orthotopic heart transplant recipients without clinical evidence of rejection"],"prefix":"10.1111","volume":"36","author":[{"given":"Aasim","family":"Afzal","sequence":"first","affiliation":[{"name":"Center for Advanced Heart and Lung Disease Baylor University Medical Center  Dallas Texas USA"},{"name":"Annette C. and Harold C. Simmons Transplant Institute Baylor Scott &amp; White Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3040-3957","authenticated-orcid":false,"given":"Amit","family":"Alam","sequence":"additional","affiliation":[{"name":"Center for Advanced Heart and Lung Disease Baylor University Medical Center  Dallas Texas USA"},{"name":"Annette C. and Harold C. Simmons Transplant Institute Baylor Scott &amp; White Health  Dallas Texas USA"},{"name":"Texas A&amp;M University Health Science Center College of Medicine  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4205-9214","authenticated-orcid":false,"given":"Johanna S.","family":"van Zyl","sequence":"additional","affiliation":[{"name":"Texas A&amp;M University Health Science Center College of Medicine  Dallas Texas USA"},{"name":"Baylor Scott &amp; White Research Institute  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hira","family":"Zafar","sequence":"additional","affiliation":[{"name":"Baylor Scott &amp; White Research Institute  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7200-8755","authenticated-orcid":false,"given":"Joost","family":"Felius","sequence":"additional","affiliation":[{"name":"Texas A&amp;M University Health Science Center College of Medicine  Dallas Texas USA"},{"name":"Baylor Scott &amp; White Research Institute  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4894-396X","authenticated-orcid":false,"given":"Shelley A.","family":"Hall","sequence":"additional","affiliation":[{"name":"Center for Advanced Heart and Lung Disease Baylor University Medical Center  Dallas Texas USA"},{"name":"Annette C. and Harold C. Simmons Transplant Institute Baylor Scott &amp; White Health  Dallas Texas USA"},{"name":"Texas A&amp;M University Health Science Center College of Medicine  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra A.","family":"Carey","sequence":"additional","affiliation":[{"name":"Center for Advanced Heart and Lung Disease Baylor University Medical Center  Dallas Texas USA"},{"name":"Annette C. and Harold C. Simmons Transplant Institute Baylor Scott &amp; White Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3007803"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9051480"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15339"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2005.03.019"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2013.08.011"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2020.11.008"},{"key":"e_1_2_8_8_1","unstructured":"American Society of Echocardiography.The American society of echocardiography recommendations for the evaluation of left ventricular diastolic function by echocardiography: a quick reference guide from the ASE workflow and lab management task force.2019;https:\/\/www.asecho.org\/wp\u2010content\/uploads\/2019\/03\/Left\u2010Ventricular\u2010Diastolic\u2010Function\u2010Summary\u2010Doc.\u2010to\u2010Publish.pdf"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15289"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1517494112"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.049098"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016091034"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1989.03420240075030"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e328259c33b"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.14549","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.14549","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.14549","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T11:59:42Z","timestamp":1693137582000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.14549"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,17]]},"references-count":13,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1111\/ctr.14549"],"URL":"https:\/\/doi.org\/10.1111\/ctr.14549","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,17]]},"assertion":[{"value":"2021-09-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14549"}}