{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T03:37:18Z","timestamp":1788233838559,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA) offers a non\u2010invasive biomarker for detecting allograft injury. However, its performance in predominantly living\u2010donor transplant settings in Asian populations remains underexplored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a multicenter prospective pilot study, 73 living\u2010donor kidney transplant (LKT) recipients from Japan underwent plasma dd\u2010cfDNA testing and protocol biopsies approximately 1 year post\u2010transplant. Diagnostic performance of dd\u2010cfDNA for subclinical antibody\u2010mediated rejection (AMR) was evaluated at 1.0% and 0.5% cut\u2010off thresholds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight patients (11.0%) were diagnosed with subclinical active AMR. Patients with dd\u2010cfDNA \u22651.0% showed significantly higher incidence of AMR compared to those with dd\u2010cfDNA &lt;1.0% (80%\u00a0vs. 5.9%, <jats:italic>p<\/jats:italic> &lt; 0.001). ROC analysis revealed an AUC of 0.85 for dd\u2010cfDNA in diagnosing AMR. Lowering the threshold to 0.5% improved sensitivity while maintaining high specificity. Patients with persistent donor\u2010specific antibodies (DSA) at 1\u2010year follow\u2010up exhibited significantly higher dd\u2010cfDNA levels. Neither HLA nor ABO incompatibility nor donor\u2010recipient relation significantly affected dd\u2010cfDNA levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>dd\u2010cfDNA demonstrates high negative predictive value and complements DSA testing for early detection of subclinical AMR in living\u2010donor transplants. This pilot study provides foundational evidence for dd\u2010cfDNA\u2010based surveillance strategies in Asian cohorts.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.70221","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T13:39:51Z","timestamp":1750945191000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Donor\u2010Derived Cell\u2010Free DNA for Diagnosing Subclinical Rejection: A Pilot Multicenter Study in Japanese Living\u2010Donor Kidney Transplantation"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3343-6674","authenticated-orcid":false,"given":"Toshihito","family":"Hirai","sequence":"first","affiliation":[{"name":"Department of Urology Tokyo Women's Medical University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taro","family":"Banno","sequence":"additional","affiliation":[{"name":"Department of 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