{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:14:37Z","timestamp":1793301277932,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,8,22]],"date-time":"2021-08-22T00:00:00Z","timestamp":1629590400000},"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":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Endomyocardial biopsy (EMB) is costly and discomforting yet remains a key component of surveillance after pediatric heart transplantation (HT). Donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA) has been histologically validated with high negative predictive value, offering an alternative to surveillance EMB (sEMB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We implemented an alternative surveillance protocol using commercially available dd\u2010cfDNA assays in place of sEMB after pediatric HT. Recipients \u22677\u00a0months post\u2010HT with reassuring clinical assessment were referred for dd\u2010cfDNA. When not elevated above the manufacturers' threshold, sEMB was deferred. Subsequent clinical status and results of follow\u2010up EMB were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over 17\u00a0months, 58 recipients [34% female, median age at HT 3.1\u00a0years (IQR 0.6\u201310.6)] had dd\u2010cfDNA assessed per protocol. Median age was 14.8\u00a0years (8.4\u201318.3) and time from HT 6.0\u00a0years (2.2\u201311.2). Forty\u2010seven (81%) had non\u2010elevated dd\u2010cfDNA and 11 (19%) were elevated. During a median of 8.7\u00a0months (4.2\u201315), all are alive without allograft loss\/new dysfunction. Among those with non\u2010elevated dd\u2010cfDNA, 24 (51%) had subsequent sEMB at 12.1\u00a0months (6.9\u201312.9) with 23\u00a0showing no acute rejection (AR): grade 0R\/pAMR0 (<jats:italic>n<\/jats:italic>\u00a0=\u00a016); 1R(1A)\/pAMR0 (<jats:italic>n<\/jats:italic>\u00a0=\u00a07). One had AR (grade 2R(3A)\/pAMR0) on follow\u2010up sEMB after decreased immunosuppression following a diagnosis of PTLD. All 11 with elevated dd\u2010cfDNA had reflex EMB at 19\u00a0days (12\u201332) with AR in 4: grade 1R(1B\u20102)\/pAMR0 (<jats:italic>n<\/jats:italic>\u00a0=\u00a03); 1R(1B)\/pAMR2 (<jats:italic>n<\/jats:italic>\u00a0=\u00a01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>dd\u2010cfDNA assessment in place of selected, per\u2010protocol EMB decreased surveillance EMB by 81% in our pediatric HT recipient cohort with no short\u2010term adverse outcomes. Individual center approach to surveillance EMB will influence the utility of these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14124","type":"journal-article","created":{"date-parts":[[2021,8,22]],"date-time":"2021-08-22T15:18:46Z","timestamp":1629645526000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Early findings after integration of donor\u2010derived cell\u2010free DNA into clinical care following pediatric heart transplantation"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4244-709X","authenticated-orcid":false,"given":"Brian","family":"Feingold","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh PA USA"},{"name":"Clinical and Translational Science University of Pittsburgh School of Medicine Pittsburgh PA USA"},{"name":"Hillman Center for Pediatric Transplantation UPMC Children's 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