{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T14:27:16Z","timestamp":1782311236346,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T00:00:00Z","timestamp":1730764800000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016477","name":"CareDx","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016477","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Serial monitoring of dd\u2010cfDNA and change from baseline can provide meaningful information beyond absolute thresholds. We describe dd\u2010cfDNA trajectories from the baseline before and after acute rejection (AR) and de novo donor\u2010specific antibodies (dnDSA) detection in kidney transplant recipients (KTRs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included KTR from 02\/2019 to 03\/2022 with serial dd\u2010cfDNA. The primary analysis compared the time\u2010varying change in dd\u2010cfDNA from baseline in KTR first AR on biopsy [AR] to patients with no\u2010AR on biopsy [no\u2010AR].<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>151 KTR were analyzed (AR\u00a0=\u00a056 KTR, no\u2010AR\u00a0=\u00a095 KTRs). In the AR group, dd\u2010cfDNA rose ahead of diagnosis: median rise from baseline was 75% at \u22123 months, 32% at \u22122 months, and 325% at \u22121 month before biopsy. At the time of biopsy, the median rise in dd\u2010cfDNA from baseline was 291% (IQR [interquartile range] 88%\u20131081%) in AR and 17% (IQR 0%\u2013 194%) in no\u2010AR (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). Following treatment, dd\u2010cfDNA values fell in the AR group with a median change from baseline of 94.7% at +1 month, 10.5% at +2 months, and 0% at +3 months. These trajectories were not observed in the no\u2010AR group. Similarly, there were no significant differences in eGFR (estimated glomerular filtration rate) trajectories between the two groups. The median change from baseline to dnDSA detection was 141% (IQR 112%\u2013574%). In KTRs with persistent rejection, median dd\u2010cfDNA was 0.95% (IQR 0.44\u20131.8) compared to 0.19% (IQR 0.12\u20130.31) in subjects with no rejection on follow\u2010up (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The significant changes from baseline observed before and after AR show how serial monitoring enhances dd\u2010cfDNA utility and allows for earlier identification of evolving injury and monitoring treatment response.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.70019","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T12:59:57Z","timestamp":1730811597000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Changes in Donor\u2010Derived Cell\u2010Free DNA Before and After Rejection and De Novo DSA Detection in Primary and Repeat Kidney Transplant Recipients"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1667-7465","authenticated-orcid":false,"given":"Sandesh","family":"Parajuli","sequence":"first","affiliation":[{"name":"Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7001-2168","authenticated-orcid":false,"given":"Neetika","family":"Garg","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ban","family":"Dodin","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Breyer","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Zona","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shree","family":"Patel","sequence":"additional","affiliation":[{"name":"CareDx, Inc  Brisbane California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Pinney","sequence":"additional","affiliation":[{"name":"CareDx, Inc  Brisbane California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3326-8583","authenticated-orcid":false,"given":"Didier","family":"Mandelbrot","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health  Madison Wisconsin 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