{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:31:19Z","timestamp":1791851479242,"version":"4.3.4"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>The prognostic value of donor-derived cell-free DNA (dd-cfDNA) for long-term kidney allograft outcomes after indication biopsy remains incompletely defined. In this prospective single-center cohort, 106 kidney transplant recipients with 108 indication biopsies were assessed for dd-cfDNA at biopsy and at 7, 30, and 90\u00a0days thereafter. dd-cfDNA was analyzed as a continuous, threshold-based, and longitudinal time-dependent variable. Clinical endpoints included \u226530% eGFR decline within 2\u00a0years, indication for re-biopsy, and graft failure. Persistent elevation of dd-cfDNA (\u22650.5% at 90 days) occurred in 7.4% of patients, with 50% requiring re-biopsy and 37.5% developing graft failure. A single measurement \u22651.0% significantly predicted \u226530% eGFR decline (HR 2.28; 95% CI 1.03\u20135.05), whereas levels \u22650.5% were less discriminative. In multivariable time-dependent Cox models adjusted for age, sex, time from transplantation to biopsy, baseline eGFR, baseline proteinuria, and Banff domain scores, longitudinal dd-cfDNA remained independently associated with \u226530% eGFR decline (HR 1.68; 95% CI 1.12\u20132.51), re-biopsy (HR 1.88; 95% CI 1.38\u20132.55), and graft failure (HR 3.42; 95% CI 2.00\u20135.86). In conclusion, dd-cfDNA levels, particularly when assessed longitudinally, are associated with adverse allograft outcomes after indication biopsy and may provide relevant prognostic information beyond a single measurement.<\/jats:p>","DOI":"10.3389\/ti.2026.15929","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:10:17Z","timestamp":1773295817000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Longitudinal Monitoring of Donor-Derived Cell-Free DNA Supports Risk Stratification in Kidney Transplant Recipients With Allograft Dysfunction"],"prefix":"10.3389","volume":"39","author":[{"given":"Iris","family":"Schr\u00f6ter","sequence":"first","affiliation":[{"name":"Department of Nephrology, University Hospital Heidelberg","place":["Heidelberg, 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