{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:57:48Z","timestamp":1791215868662,"version":"4.1.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Black heart transplant patients are at higher risk of acute rejection (AR) and death than White patients. We hypothesized that this risk may be associated with higher levels of donor-derived cell-free DNA (dd-cfDNA) and cell-free mitochondrial DNA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>The Genomic Research Alliance for Transplantation is a multicenter, prospective, longitudinal cohort study. Sequencing was used to quantitate dd-cfDNA and polymerase chain reaction to quantitate cell-free mitochondrial DNA in plasma. AR was defined as \u22652R cellular rejection or \u22651 antibody-mediated rejection. The primary composite outcome was AR, graft dysfunction (left ventricular ejection fraction &lt;50% and decrease by \u226510%), or death.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              We included 148 patients (65 Black patients and 83 White patients), median age was 56 years and 30% female sex. The incidence of AR was higher in Black patients compared with White patients (43% versus 19%;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.002). Antibody-mediated rejection occurred predominantly in Black patients with a prevalence of 20% versus 2% (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). After transplant, Black patients had higher levels of dd-cfDNA, 0.09% (interquartile range, 0.001\u20130.30) compared with White patients, 0.05% (interquartile range, 0.001\u20130.23;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.003). Beyond 6 months, Black patients showed a persistent rise in dd-cfDNA with higher levels compared with White patients. Cell-free mitochondrial DNA was higher in Black patients (185\u2005788 copies\/mL; interquartile range, 101\u2009252\u2013422\u2009133) compared with White patients (133\u2009841 copies\/mL; interquartile range, 75\u2005346\u2013337\u2005990;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). The primary composite outcome occurred in 43% and 55% of Black patients at 1 and 2 years, compared with 23% and 27% in White patients,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001. In a multivariable model, Black patient race (hazard ratio, 2.61 [95% CI, 1.35\u20135.04];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.004) and %dd-cfDNA (hazard ratio, 1.15 [95% CI, 1.03\u20131.28];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.010) were associated with the primary composite outcome.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Elevated dd-cfDNA and cell-free mitochondrial DNA after heart transplant may mechanistically be implicated in the higher incidence of AR and worse clinical outcomes in Black transplant recipients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02423070.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.123.011160","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T10:12:13Z","timestamp":1708423933000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Racial Differences in Donor-Derived Cell-Free DNA and Mitochondrial DNA After Heart Transplantation, on Behalf of the GRAfT Investigators"],"prefix":"10.1161","volume":"17","clinical-trial-number":[{"clinical-trial-number":"nct02423070","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8175-168X","authenticated-orcid":true,"given":"Palak","family":"Shah","sequence":"first","affiliation":[{"name":"Heart Failure, Mechanical Circulatory Support &amp; Transplant, Inova Schar Heart and Vascular, Falls Church, VA (P.S., S.S.S., L.H., E.M.)."},{"name":"Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A.-E., T.E.A., M.K.J., H.A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9380-9161","authenticated-orcid":true,"given":"Sean","family":"Agbor-Enoh","sequence":"additional","affiliation":[{"name":"Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A.-E., T.E.A., M.K.J., H.A.V.)."},{"name":"Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (S.A.-E., S.H.)."},{"name":"Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, MD (S.A.-E., T.E.A., H.K., W.P., M.K.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0658-7458","authenticated-orcid":true,"given":"Seiyon","family":"Lee","sequence":"additional","affiliation":[{"name":"Volgenau School of Engineering, George Mason University, Fairfax, VA (S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2888-1316","authenticated-orcid":true,"given":"Temesgen E.","family":"Andargie","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (S.A.-E., S.H.)."},{"name":"Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, MD (S.A.-E., T.E.A., H.K., W.P., M.K.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6249-2598","authenticated-orcid":true,"given":"Shashank S.","family":"Sinha","sequence":"additional","affiliation":[{"name":"Heart Failure, Mechanical Circulatory Support &amp; Transplant, Inova Schar Heart and Vascular, Falls Church, VA (P.S., S.S.S., L.H., E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7540-2045","authenticated-orcid":true,"given":"Hyesik","family":"Kong","sequence":"additional","affiliation":[{"name":"Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, MD (S.A.-E., T.E.A., H.K., W.P., M.K.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Henry","sequence":"additional","affiliation":[{"name":"Heart Failure, Mechanical Circulatory Support &amp; Transplant, Inova Schar Heart and Vascular, Falls Church, VA (P.S., S.S.S., L.H., E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9982-0057","authenticated-orcid":true,"given":"Woojin","family":"Park","sequence":"additional","affiliation":[{"name":"Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, MD (S.A.-E., T.E.A., H.K., W.P., M.K.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"McNair","sequence":"additional","affiliation":[{"name":"Heart Failure, Mechanical Circulatory Support &amp; Transplant, Inova Schar Heart and Vascular, Falls Church, VA (P.S., S.S.S., L.H., E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inna","family":"Tchoukina","sequence":"additional","affiliation":[{"name":"The Pauley Heart Center, Virginia Commonwealth University, Richmond (I.T., K.B.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyur B.","family":"Shah","sequence":"additional","affiliation":[{"name":"The Pauley Heart Center, Virginia Commonwealth University, Richmond (I.T., K.B.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9149-416X","authenticated-orcid":true,"given":"Samer S.","family":"Najjar","sequence":"additional","affiliation":[{"name":"Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington DC (S.S.N., M.E.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8384-2638","authenticated-orcid":true,"given":"Steven","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (S.A.-E., S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Rodrigo","sequence":"additional","affiliation":[{"name":"Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington DC (S.S.N., M.E.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1657-2877","authenticated-orcid":true,"given":"Moon Kyoo","family":"Jang","sequence":"additional","affiliation":[{"name":"Genomic Research Alliance for Transplantation (GRAfT), Bethesda, MD (P.S., S.A.-E., T.E.A., M.K.J., H.A.V.)."},{"name":"Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, MD (S.A.-E., T.E.A., H.K., W.P., M.K.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6844-209X","authenticated-orcid":true,"given":"Charles","family":"Marboe","sequence":"additional","affiliation":[{"name":"Department of Pathology, New York Presbyterian University Hospital of Cornell and Columbia (C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6176-2629","authenticated-orcid":true,"given":"Gerald J.","family":"Berry","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine, Palo Alto, CA (G.J.B., H.A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2948-9503","authenticated-orcid":true,"given":"Hannah A.","family":"Valantine","sequence":"additional","affiliation":[{"name":"Genomic Research Alliance 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