{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T07:35:49Z","timestamp":1793000149118,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Allograft rejection remains a leading cause of morbidity in pediatric heart transplant (HT) recipients. Endomyocardial biopsy (EMB), the standard for surveillance, is invasive and resource\u2010intensive. Donor\u2010derived cell\u2010free DNA (dd\u2010cfDNA) is a promising noninvasive biomarker, though pediatric data remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We performed a retrospective cohort study of 50 pediatric HT recipients (&lt;\u200918\u2009years) at a single quaternary center. Medium\u2010 and high\u2010risk patients managed with a dd\u2010cfDNA\u2013guided protocol (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925) were compared with a historical biopsy\u2010based cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925). Primary outcomes included biopsy frequency and incidence of clinically significant rejection (ACR \u2265\u20092R, pAMR \u2265\u20092, or treated rejection) over the first year post\u2010HT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The dd\u2010cfDNA group underwent fewer biopsies (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), with only 4% requiring \u2265\u20095 biopsies versus 16% in controls. There was no difference in 12\u2010month rejection incidence (39% vs. 25%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.99). Biopsy yield was higher in the dd\u2010cfDNA group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.053). Among rejection episodes, 88% were preceded by increased dd\u2010cfDNA, with a significant relative rise within 30\u2009days (104%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In medium\u2010 and high\u2010risk pediatric HT recipients, dd\u2010cfDNA\u2013guided surveillance reduced biopsy utilization without increasing rejection. These findings support dd\u2010cfDNA as a clinically useful adjunct to optimize surveillance strategies in pediatric transplantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70482","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:56:11Z","timestamp":1791525371000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Donor\u2010Derived Cell\u2010Free\n                    <scp>DNA<\/scp>\n                    \u2013Guided Rejection Surveillance in Medium\u2010 and High\u2010Risk Pediatric Heart Transplant Recipients: A Single\u2010Center Experience"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8531-0475","authenticated-orcid":false,"given":"Stephanie","family":"Ghaleb","sequence":"first","affiliation":[{"name":"Department of Pediatrics Children's Medical Center of Dallas\/University of Texas Southwestern  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0679-908X","authenticated-orcid":false,"given":"Nathanya","family":"Baez\u2010Hernandez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Medical Center of Dallas\/University of Texas Southwestern  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey","family":"Ellimuttil","sequence":"additional","affiliation":[{"name":"Children's Medical Center of Dallas  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5964-5055","authenticated-orcid":false,"given":"Laura","family":"Radel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Medical Center of Dallas\/University of Texas Southwestern  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2684-0027","authenticated-orcid":false,"given":"Melodie","family":"Lynn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Medical Center of Dallas\/University of Texas Southwestern  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1279-8369","authenticated-orcid":false,"given":"Maria","family":"Bano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Medical Center of Dallas\/University of Texas Southwestern  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7130-7056","authenticated-orcid":false,"given":"Ryan","family":"Butts","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Medical Center of Dallas\/University of Texas Southwestern  Dallas Texas 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