{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T17:06:13Z","timestamp":1789837573708,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T00:00:00Z","timestamp":1605830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>In pediatric transplantation, acute rejection is a major contributor of graft failure. Current approaches include kidney biopsy in response to graft dysfunction and\/or the emergence of donor\u2010specific HLA antibodies (DSA). However, biopsy is associated with potential complications. Thus, there is a need for non\u2010invasive diagnostics. Detection of donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA, AlloSure) &gt; 1% is associated with rejection in adult kidney transplants. Here, we evaluate the utility of dd\u2010cfDNA for identifying allograft rejection in pediatric patients. Between 10\/2017 and 10\/2019, 67 patients, who underwent initial testing with dd\u2010cfDNA as part of routine monitoring or in response to clinical suspicion for rejection, were included. Biopsies were performed when dd\u2010cfDNA &gt; 1.0% or where clinical suspicion was high. Demographics, dd\u2010cfDNA, antibody status, and biopsies were collected prospectively. Data were analyzed to determine predictive value of dd\u2010cfDNA for identifying grafts at risk for rejection. 19 of 67 patients had dd\u2010cfDNA testing as part of routine monitoring with a median dd\u2010cfDNA score of 0.37 (IQR: 0.19\u20101.10). 48 of 67 patients who had clinical suspicion of rejection had median dd\u2010cfDNA score of 0.47 (0.24\u20102.15). DSA\u2010positive recipients had higher dd\u2010cfDNA scores than those who were negative or had AT1R positivity alone (<jats:italic>P<\/jats:italic> = .003). There was no association between dd\u2010cfDNA score and strength of DSA positivity. 7 of 48 recipients had a biopsy with a dd\u2010cfDNA score &lt;1%; two showed evidence of rejection. Neither DSA nor AT1R positivity was statistically associated with biopsy\u2010proven rejection. However, dd\u2010cfDNA &gt;1% was diagnostic of rejection with sensitivity of 86% and specificity of 100% (AUC: 0.996, 0.98\u20101.00; <jats:italic>P<\/jats:italic> = .002). dd\u2010cfDNA represents a non\u2010invasive method for early detection of rejection in pediatric renal transplants. Our study shows dd\u2010cfDNA to be highly predictive of histological rejection and superior to other indicators such as graft dysfunction or antibody positivity alone. Further studies are necessary to refine these initial observations.<\/jats:p>","DOI":"10.1111\/petr.13850","type":"journal-article","created":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T06:40:10Z","timestamp":1605940810000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA) for detection of allograft rejection in pediatric kidney transplants"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6988-8533","authenticated-orcid":false,"given":"Dechu P.","family":"Puliyanda","sequence":"first","affiliation":[{"name":"Pediatric Nephrology Cedars Sinai Medical Center  Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Swinford","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology UTHealth University of Texas at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Pizzo","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Cedars Sinai Medical Center  Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Garrison","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Cedars Sinai Medical Center  Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra M.","family":"De Golovine","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology UTHealth University of Texas at Houston  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley C.","family":"Jordan","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Cedars Sinai Medical Center  Los Angeles CA 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