{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:03:26Z","timestamp":1785301406648,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"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 (dd-cfDNA) is a promising noninvasive marker of graft injury after lung transplantation (LTx), but its real-world value for identifying rejection-associated allograft injury and its interpretation across infection status and transplant procedures remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study consecutively included LTx recipients undergoing inpatient follow-up and dd-cfDNA testing from February 2024 to March 2026. Analyses used observations obtained \u22651 month after LTx. Diagnostic performance was assessed by ROC analysis, and the association between dd-cfDNA (%) and clinically diagnosed rejection was evaluated by multivariable logistic regression. Single- and double-LTx recipients were compared, and a stable-state correction factor was explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 161 recipients, 218 dd-cfDNA tests were performed; 196 non-perioperative observations were analyzed, including 64 rejection and 132 non-rejection observations. Both dd-cfDNA (%) and dd-cfDNA (copies\/mL) were higher in rejection. dd-cfDNA (%) yielded an AUC of 0.677 (95% CI, 0.600-0.755), with a cutoff of 1.03% (sensitivity, 90.6%; specificity, 40.9%). dd-cfDNA (copies\/mL) yielded an AUC of 0.666 (95% CI, 0.584-0.748), with a cutoff of 104.10 copies\/mL (sensitivity, 48.4%; specificity, 78.8%). dd-cfDNA (%) remained independently associated with rejection (adjusted OR, 1.36; 95% CI, 1.15-1.62; P&amp;lt;0.001). Single-LTx recipients had lower dd-cfDNA (%) than double-LTx recipients under stable and rejection conditions; this difference was attenuated after correction (CF\u00a0=\u00a01.54).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>dd-cfDNA may serve as a noninvasive adjunct for identifying rejection-associated allograft injury after LTx. Infection and transplant procedure should be considered during interpretation, and stable-state correction may improve comparability between single- and double-LTx recipients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1895278","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:44:45Z","timestamp":1785300285000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Donor-derived cell-free DNA testing for noninvasive monitoring of allograft rejection after lung transplantation"],"prefix":"10.3389","volume":"17","author":[{"given":"Shuo","family":"Ding","sequence":"first","affiliation":[{"name":"Department of General Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine","place":["Hangzhou, China"]},{"name":"Key Laboratory of Multiple Organ Failure (Zhejiang University), Ministry of Education","place":["Hangzhou, 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of Education","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyu","family":"Chen","sequence":"additional","affiliation":[{"name":"Lung Transplantation Center, The Second Affiliated Hospital of Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of General Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine","place":["Hangzhou, China"]},{"name":"Key Laboratory of Multiple Organ Failure (Zhejiang University), Ministry of Education","place":["Hangzhou, China"]},{"name":"Lung Transplantation Center, The Second Affiliated Hospital of Zhejiang University School of Medicine","place":["Hangzhou, China"]},{"name":"Binjiang Institute of Zhejiang University","place":["Hangzhou, 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