{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:29:23Z","timestamp":1775032163388,"version":"3.50.1"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"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. Med."],"abstract":"<jats:p>\n                    Gastroesophageal reflux disease (GERD) and bile acid micro-aspiration are risk factors for the development of chronic lung allograft dysfunction (CLAD) after lung transplantation (LT). Donor-derived cell-free DNA (dd-cfDNA) is a clinically validated plasma biomarker for acute rejection but also detects other types of allograft injury and can potentially be used to detect GERD and micro-aspiration. Here, we report a five-case single-center series of LT patients with confirmed GERD and micro-aspiration, treated by Toupet fundoplication and adjunctive laparoscopic procedures. dd-cfDNA fraction measured pre\n                    <jats:italic>-<\/jats:italic>\n                    and post\n                    <jats:italic>-<\/jats:italic>\n                    intervention demonstrated a decreasing trend in the state of molecular injury: 3.24% (IQR, 1.675\u20138.71) vs. 0.75% (0.165\u20131.825;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.0625), respectively. All patients experienced clinical improvement (assessed by spirometry or resolution of recurrent aspiration pneumonia events). These data suggest that dd-cfDNA may have expanded utility as a non-invasive clinical tool to identify molecular injury sequelae of gastroesophageal reflux. Given the limited effective treatment options for CLAD, we envision an opportunity for the use of dd-cfDNA to reduce the risk of CLAD development when GERD is involved.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1792506","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:39:45Z","timestamp":1775021985000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lung allograft injury improves after gastroesophageal reflux surgery by donor-derived cell-free DNA kinetics"],"prefix":"10.3389","volume":"13","author":[{"given":"Samir","family":"Sultan","sequence":"first","affiliation":[{"name":"Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon C.","family":"Gould","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew S.","family":"Kastenmeier","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gokulakrishnan","family":"Balasubramanian","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin","place":["Milwaukee, WI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niraja","family":"Suresh","sequence":"additional","affiliation":[{"name":"Natera Inc.","place":["Austin, TX, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Ross","sequence":"additional","affiliation":[{"name":"Natera Inc.","place":["Austin, TX, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S422","DOI":"10.1016\/j.ajt.2025.01.025","article-title":"OPTN\/SRTR 2023 annual data report: lung","volume":"25","author":"Valapour","year":"2025","journal-title":"Am J Transplant"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"S286","DOI":"10.1016\/j.healun.2022.01.703","article-title":"Survival after lung transplantation in Europe - Clad as major cause of death","volume":"41","author":"Hofstetter","year":"2022","journal-title":"J Heart Lung Transplant"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1055\/s-0041-1729175","article-title":"Chronic lung allograft dysfunction: evolving concepts and therapies","volume":"42","author":"Amubieya","year":"2021","journal-title":"Semin Respir Crit Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1016\/j.jtcvs.2004.10.035","article-title":"Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation","volume":"129","author":"D\u2019Ovidio","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1016\/j.healun.2020.05.006","article-title":"Bronchoalveolar bile acid and inflammatory markers to identify high-risk lung transplant recipients with reflux and microaspiration","volume":"39","author":"Zhang","year":"2020","journal-title":"J Heart Lung Transplant"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"7491","DOI":"10.1007\/s00464-024-11180-4","article-title":"Noninvasive biomarkers for the detection of GERD-induced pulmonary injury","volume":"38","author":"Latorre-Rodr\u00edguez","year":"2024","journal-title":"Surg Endosc"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2657","DOI":"10.1097\/tp.0000000000002665","article-title":"Analytical validation of a single-nucleotide polymorphism-based donor-derived cell-free DNA assay for detecting rejection in kidney transplant patients","volume":"103","author":"Altu\u011f","year":"2019","journal-title":"Transplantation"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e1317","DOI":"10.1097\/txd.0000000000001317","article-title":"Clinical validation of a plasma donor-derived cell-free DNA assay to detect allograft rejection and injury in lung transplant","volume":"8","author":"Rosenheck","year":"2022","journal-title":"Transplant Direct"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1016\/j.healun.2021.04.009","article-title":"Donor-derived cell-free DNA accurately detects acute rejection in lung transplant patients, a multicenter cohort study","volume":"40","author":"Jang","year":"2021","journal-title":"J Heart Lung Transplant"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1097\/tp.0000000000005162","article-title":"Chronic lung allograft dysfunction: clinical manifestations and immunologic mechanisms","volume":"109","author":"Bery","year":"2025","journal-title":"Transplantation"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1016\/j.healun.2024.04.064","article-title":"Extreme elevations of donor-derived cell-free DNA increases the risk of chronic lung allograft dysfunction and death, even without clinical manifestations of disease","volume":"43","author":"Keller","year":"2024","journal-title":"J Heart Lung Transplant"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1792506\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:39:46Z","timestamp":1775021986000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1792506\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":11,"alternative-id":["10.3389\/fmed.2026.1792506"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1792506","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1792506"}}