{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:05:01Z","timestamp":1790690701878,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Accurate differentiation of acute rejection (AR) from other causes of graft dysfunction after liver transplantation remains challenging in real\u2010world clinical practice. Although donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA) has emerged as a promising non\u2010invasive biomarker of graft injury, its specificity may be limited in clinically suspected rejection due to concurrent inflammatory and non\u2010rejection\u2010related graft injuries. Immune activation markers may provide complementary information by reflecting ongoing alloimmune responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective diagnostic study, we enrolled liver transplant recipients presenting with graft dysfunction and classified them as AR or non\u2010rejection based on biopsy. Plasma dd\u2010cfDNA levels and peripheral immune activation markers, including interleukin\u20102 receptor (IL\u20102R) and activated T\u2010cell subsets, were measured. Diagnostic performance was evaluated using receiver operating characteristic analysis and multivariable models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 33 patients were included, comprising 18 with biopsy\u2010proven AR and 15 with non\u2010rejection graft dysfunction. dd\u2010cfDNA levels were significantly higher in AR patients. Selected immune activation markers demonstrated complementary diagnostic characteristics. A simplified combined model integrating dd\u2010cfDNA percentage with activated T\u2010cell subsets achieved improved discrimination compared with individual markers. Decision curve analysis indicated a higher net clinical benefit across a range of threshold probabilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integration of dd\u2010cfDNA with immune activation markers provides a complementary non\u2010invasive strategy for evaluating acute rejection in liver transplant recipients with clinically suspected graft dysfunction. This approach may improve real\u2010world diagnostic assessment and assist clinical decision\u2010making while reducing unnecessary liver biopsies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70701","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:12:06Z","timestamp":1790687526000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance of Donor\u2010derived Cell\u2010free DNA Combined With Immune Activation Markers for Detecting Acute Rejection After Liver Transplantation"],"prefix":"10.1111","volume":"40","author":[{"given":"Xuechun","family":"Zhao","sequence":"first","affiliation":[{"name":"Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Ministry of Education  Wuhan Hubei Province PR China"},{"name":"NHC Key Laboratory of Organ Transplantation  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Chinese Academy of Medical Sciences  Wuhan Hubei Province PR China"},{"name":"Hubei Provincial Clinical Research Center for Organ Transplantation  Wuhan Hubei Province PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Yang","sequence":"additional","affiliation":[{"name":"Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Ministry of Education  Wuhan Hubei Province PR China"},{"name":"NHC Key Laboratory of Organ Transplantation  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Chinese Academy of Medical Sciences  Wuhan Hubei Province PR China"},{"name":"Hubei Provincial Clinical Research Center for Organ Transplantation  Wuhan Hubei Province PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Jiang","sequence":"additional","affiliation":[{"name":"Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Ministry of Education  Wuhan Hubei Province PR China"},{"name":"NHC Key Laboratory of Organ Transplantation  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Chinese Academy of Medical Sciences  Wuhan Hubei Province PR China"},{"name":"Hubei Provincial Clinical Research Center for Organ Transplantation  Wuhan Hubei Province PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Ministry of Education  Wuhan Hubei Province PR China"},{"name":"NHC Key Laboratory of Organ Transplantation  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Chinese Academy of Medical Sciences  Wuhan Hubei Province PR China"},{"name":"Hubei Provincial Clinical Research Center for Organ Transplantation  Wuhan Hubei Province PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lai","family":"Wei","sequence":"additional","affiliation":[{"name":"Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Ministry of Education  Wuhan Hubei Province PR China"},{"name":"NHC Key Laboratory of Organ Transplantation  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Chinese Academy of Medical Sciences  Wuhan Hubei Province PR China"},{"name":"Hubei Provincial Clinical Research Center for Organ Transplantation  Wuhan Hubei Province PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhishui","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Ministry of Education  Wuhan Hubei Province PR China"},{"name":"NHC Key Laboratory of Organ Transplantation  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Chinese Academy of Medical Sciences  Wuhan Hubei Province PR China"},{"name":"Hubei Provincial Clinical Research Center for Organ Transplantation  Wuhan Hubei Province PR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Ministry of Education  Wuhan Hubei Province PR China"},{"name":"NHC Key Laboratory of Organ Transplantation  Wuhan Hubei Province PR China"},{"name":"Key Laboratory of Organ Transplantation Chinese Academy of Medical Sciences  Wuhan Hubei Province PR China"},{"name":"Hubei Provincial Clinical Research Center for Organ Transplantation  Wuhan Hubei Province PR 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