{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:15:18Z","timestamp":1771931718923,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Donor-derived cell-free DNA is an established blood-based biomarker used to assess alloimmune activity after kidney transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective study of 257 kidney transplant recipients that had at least one dd-cfDNA measurements during 3-year period. The primary aim was to assess the association between dd-cfDNA levels with graft function and survival. Secondary exploratory aims included examining the relationships between dd-cfDNA strata and biopsy-proven rejection, donor-specific antibodies, C4d deposition, and longitudinal eGFR trajectories. Patients were stratified by their highest dd-cfDNA measurement into three groups: &amp;lt;0.50%, 0.50\u20130.99%, and \u22651.0%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients categorized in the \u22651.0% dd-cfDNA group had increased rates of rejection, more severe histopathologic injury, and a higher prevalence of DSAs. With the \u2265 0.50-0.90% dd-cfDNA group having greater variability and decline in eGFR over the 3 year period. In exploratory multivariable modeling, higher dd-cfDNA strata were associated with a decline in graft function and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated dd-cfDNA levels were associated with adverse alloimmune and functional outcomes, including rejection, DSA positivity, and reduced graft survival (p=0.0071). A logistic regression model identified eGFR decline in the &amp;gt;1.0% group to predict long-term graft failure and patient survival (p=0.04). These findings support the clinical value of dd-cfDNA as a biomarker of alloimmune risk in kidney transplant recipients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1737024","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:22:53Z","timestamp":1770960173000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk stratification by donor-derived cell-free DNA: a three-year single center study of kidney transplant outcomes from 257 patients"],"prefix":"10.3389","volume":"17","author":[{"given":"Rhys","family":"Mendel","sequence":"first","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences, University at Buffalo","place":["Buffalo, NY, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kabir","family":"Jalal","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University at 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Mathematics","place":["Durham, NC, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Sorci","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Rochester School of Medicine & Dentistry","place":["Rochester, NY, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanishka","family":"Mohib","sequence":"additional","affiliation":[{"name":"Research and Development, CareDx Inc.","place":["Brisbane, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samer","family":"Kareem","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, Erie County Medical Center","place":["Buffalo, NY, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John E.","family":"Tomaszewski","sequence":"additional","affiliation":[{"name":"Department of Pathology and Anatomical Sciences, Jacobs School of Medicine & Biomedical Sciences","place":["Buffalo, NY, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon R.","family":"Von Visger","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, Erie County Medical Center","place":["Buffalo, NY, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Quigg","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, Erie County Medical Center","place":["Buffalo, NY, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirley","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, Erie County Medical Center","place":["Buffalo, NY, United 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