{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:03:40Z","timestamp":1790381020511,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute rejection (AR) is a major cause of graft loss after orthotopic heart transplant (OHT). Donor\u2010derived cell\u2010free DNA fraction (dd\u2010cfDNA%) is a noninvasive biomarker for AR but may be elevated without AR. We evaluated associations of donor\u2010recipient size mismatch and recipient age with early dd\u2010cfDNA% in pediatric OHT recipients without AR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center retrospective study evaluated initial dd\u2010cfDNA% testing in pediatric OHT recipients without AR. Size mismatch was assessed using donor\u2010to\u2010recipient body surface area (BSA) ratio, weight ratio, and allograft left ventricular (LV) mass z\u2010score. Associations with dd\u2010cfDNA% were assessed using Spearman correlation and Mann\u2013Whitney U tests; multivariable linear regression adjusted for age. Analyses of size mismatch and recipient age were repeated at the second post\u2010OHT dd\u2010cfDNA assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between 2022 and 2025, 58 pediatric OHT recipients underwent dd\u2010cfDNA% testing; 39 had no rejection. After excluding 2 outliers, 37 remained. Higher first dd\u2010cfDNA% was associated with larger BSA ratio (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.039), BSA ratio \u2265\u20091.5 (median 0.17% vs. 0.06%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0185), larger weight ratio (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016), LV mass oversizing (median 0.17% vs. 0.06%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0196), and younger age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). After age adjustment, neither size mismatch nor age was independently associated with first dd\u2010cfDNA%. No significant associations were observed at the second assessment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Greater donor\u2010recipient size mismatch and younger recipient age were associated with higher first dd\u2010cfDNA% in unadjusted analyses, but not after age adjustment. These exploratory findings support further investigation of size mismatch, recipient age, and early allograft adaptation as potential non\u2010rejection contributors to dd\u2010cfDNA elevation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70461","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:15:51Z","timestamp":1789798551000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Donor\u2010Recipient Size Mismatch, Age at Transplant, and Elevated Donor\u2010Derived Cell\u2010Free\n                    <scp>DNA<\/scp>\n                    % Early After Pediatric Heart Transplant"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5133-8242","authenticated-orcid":false,"given":"Alice M.","family":"Tao","sequence":"first","affiliation":[{"name":"Department of Pediatrics Columbia University Vagelos College of Physicians and Surgeons and NewYork\u2010Presbyterian Morgan Stanley Children's Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9688-0879","authenticated-orcid":false,"given":"Irene D.","family":"Lytrivi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics Columbia University Vagelos College of Physicians and Surgeons and NewYork\u2010Presbyterian Morgan Stanley Children's Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4668-4941","authenticated-orcid":false,"given":"Aine","family":"Lynch","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics Columbia University Vagelos College of Physicians and Surgeons and NewYork\u2010Presbyterian Morgan Stanley Children's Hospital  New York New York 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