{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:42:01Z","timestamp":1789663321497,"version":"4.0.1"},"reference-count":8,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"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":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA) is increasingly used as a noninvasive marker of kidney allograft injury, but adult\u2010derived cutoffs may not be applicable to pediatric recipients, particularly in the setting of donor\u2013recipient size mismatch. We evaluated dd\u2010cfDNA levels in stable pediatric kidney transplant (KT) recipients and assessed variation by recipient weight and donor body mass index (BMI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective data were collected from seven U.S. pediatric KT centers. Clinically stable recipients &lt;\u200918\u2009years of age (no de novo donor specific antibody, biopsy\u2010proven rejection or BK viremia\/nephropathy), with \u2265\u20092 dd\u2010cfDNA measurements per year were included. Recipients were stratified by weight at dd\u2010cfDNA collection (&lt;\u200920\u2009kg, 20\u201350\u2009kg, &gt;\u200950\u2009kg). Donor BMI was categorized as underweight (\u2264\u200918.5), normal (18.6\u201324.9), overweight (25\u201329.9), or obese (\u2265\u200930). Comparisons were performed using linear mixed\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 178 recipients, mean dd\u2010cfDNA did not differ by recipient weight (&lt;\u200920\u2009kg: 0.51\u2009\u00b1\u20090.44; 20\u201350\u2009kg: 0.65\u2009\u00b1\u20091.28; &gt;\u200950\u2009kg: 0.49\u2009\u00b1\u20090.70). Median dd\u2010cfDNA was similar across donor BMI categories. However, among obese donors, recipients &lt;\u200920\u2009kg had 1.3\u2010fold higher dd\u2010cfDNA (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044). Donor\u2013recipient body surface area mismatch &gt;\u20091.5 was associated with 1.083\u2010fold higher dd\u2010cfDNA up to 5\u2009years post\u2010transplant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In stable pediatric KT recipients, dd\u2010cfDNA levels were well below the adult\u2010derived 1% cutoff, reinforcing the generalizability of this cutoff to the pediatric population. Recipients &lt;\u200920\u2009kg with donor BMI\u2009&gt;\u200930\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      or in the setting of a donor\u2010recipient BSA mismatch &gt;\u20091.5 were associated with higher dd\u2010cfDNA levels.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70416","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:20:21Z","timestamp":1786969221000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Donor\u2010Derived Cell\u2010Free\n                    <scp>DNA<\/scp>\n                    in Stable Pediatric Kidney Transplant Recipients: Influence of Donor Obesity and Recipient Size"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8601-9479","authenticated-orcid":false,"given":"Julia","family":"Steinke","sequence":"first","affiliation":[{"name":"Helen DeVos Children's Hospital  Grand Rapids Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4952-8132","authenticated-orcid":false,"given":"Lyndsay","family":"Harshman","sequence":"additional","affiliation":[{"name":"University of Iowa Stead Family Children's Hospital  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Kirshner","sequence":"additional","affiliation":[{"name":"Cedars\u2010Sinai Guerin Children's  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arundhati","family":"Kale","sequence":"additional","affiliation":[{"name":"University of California, Davis  Davis California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Winnicki","sequence":"additional","affiliation":[{"name":"University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ranch","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayanthi","family":"Chandar","sequence":"additional","affiliation":[{"name":"Miller School of Medicine University of Miami  Coral Gables Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2997-7483","authenticated-orcid":false,"given":"Helen","family":"Pizzo","sequence":"additional","affiliation":[{"name":"Cedars\u2010Sinai Guerin Children's  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshdeep","family":"Kaur","sequence":"additional","affiliation":[{"name":"University of Iowa Stead Family Children's Hospital  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Hanson","sequence":"additional","affiliation":[{"name":"Medical Affairs CareDx  Brisbane California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zunqiu","family":"Chen","sequence":"additional","affiliation":[{"name":"Biostatistics Core CareDx  Brisbane California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Shen","sequence":"additional","affiliation":[{"name":"Biostatistics Core CareDx  Brisbane California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dechu","family":"Puliyanda","sequence":"additional","affiliation":[{"name":"Cedars\u2010Sinai Guerin Children's  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2018.09.008"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2016091034"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/txd.0000000000000821"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/txd.0000000000001061"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1373\/jalm.2016.022731"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.03840322"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14582"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467\u2010025\u201006770\u2010w"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70416","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70416","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70416","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:57:44Z","timestamp":1787741864000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70416"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":8,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/petr.70416"],"URL":"https:\/\/doi.org\/10.1111\/petr.70416","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-01-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70416"}}