{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T17:19:32Z","timestamp":1789838372176,"version":"4.0.1"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Acute cellular (ACR) and antibody\u2010mediated (AMR) rejection are risk factors for allograft loss in heart transplant (HT) recipients. Endomyocardial biopsy (EMB), although considered the gold standard for rejection surveillance, is invasive and has high interobserver variability. Noninvasive donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA) sampling has a high negative predictive value (NPV) for rejection in adults and is increasingly used in pediatrics. This single center study aimed to test the performance of dd\u2010cfDNA in screening for acute rejection (AR) and donor\u2010specific antibodies (DSAs) in pediatric HT recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Blood samples for dd\u2010cfDNA were obtained per clinical protocol for all eligible HT recipients in our center from July 1, 2022 to December 31, 2023. Primary endpoints were episodes of AR, pathology grading of EMBs temporally related to ddcfDNA sampling (0\u2013150 days), and presence of DSAs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 471 interpretable samples, in 192 unique patients. Of those, 199 dd\u2010cfDNA tests were paired with EMB \u00b1 DSA in 152 patients. Abnormal dd\u2010cfDNA (&gt; 0.2%) was found in 77 samples (median 0.48%, range 0.21%\u201311%) and led to EMB, where one sample was positive for ACR (grade 2R), 13 for AMR, yielding an NPV of 97% for AMR. After excluding abnormal ddcfDNA testing associated with AR, 65 abnormal dd\u2010cfDNA tests were paired with DSA testing. The NPV of the test for detection of DSAs was 93%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Implementation of noninvasive rejection surveillance with dd\u2010cfDNA in a pediatric cohort demonstrates high NPV for AR and high DSAs, making it an ideal screening tool for long\u2010term monitoring of allograft health in pediatrics.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15481","type":"journal-article","created":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T14:30:37Z","timestamp":1729089037000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Progress in Noninvasive Surveillance for Acute Rejection in Pediatric Heart Transplant Recipients: A Real\u2010World Analysis of Donor\u2010Derived Cell\u2010Free DNA\u2010Based Surveillance Protocol"],"prefix":"10.1111","volume":"38","author":[{"given":"Leor","family":"Akabas","sequence":"first","affiliation":[{"name":"Department of Pediatrics Columbia University Vagelos College of Physicians and Surgeons Morgan Stanley Children's Hospital of New York\u2010Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Bravo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Columbia University Vagelos College of Physicians and Surgeons Morgan Stanley Children's Hospital of New York\u2010Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9837-1365","authenticated-orcid":false,"given":"Yun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Pediatric Cardiovascular Clinical Research Core Pediatric Heart Center Columbia University Vagelos College of Physicians and Surgeons Morgan Stanley Children's Hospital of New York\u2010Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Simonelli","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Columbia University Vagelos College of Physicians and Surgeons Morgan Stanley Children's Hospital of New York\u2010Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren A.","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Columbia University Vagelos College of Physicians and Surgeons Morgan Stanley Children's Hospital of New York\u2010Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc E.","family":"Richmond","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Columbia University Vagelos College of Physicians and Surgeons Morgan Stanley Children's Hospital of New York\u2010Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9688-0879","authenticated-orcid":false,"given":"Irene D.","family":"Lytrivi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Columbia University Vagelos College of Physicians and Surgeons Morgan Stanley Children's Hospital of New York\u2010Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31826e19e2"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15339"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3007803"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2019.11.015"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmoldx.2016.07.003"},{"issue":"6","key":"e_1_2_11_7_1","first-page":"587","article-title":"A Working Formulation for the Standardization of Nomenclature in the Diagnosis of Heart and Lung Rejection: Heart Rejection Study Group","volume":"9","author":"Billingham M. E.","year":"1990","journal-title":"Journal of Heart Transplantation"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2005.03.019"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2018.01.1305"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2022.04.027"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14124"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14705"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOT.0000000000000636"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-19017-7"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13970"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14708"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.049098"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.15481","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T13:42:01Z","timestamp":1748353321000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.15481"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/ctr.15481"],"URL":"https:\/\/doi.org\/10.1111\/ctr.15481","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]},"assertion":[{"value":"2024-08-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15481"}}