ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2021
Donor-derived cell-free DNA accurately detects acute rejection in lung transplant patients, a multicenter cohort study.
Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 2 of them syntheses that pooled it.
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Who cites it
59 citing papers in PubMed, 2 syntheses or guidelines pooled it, 86 citations in OpenAlex.
- International Society for Heart and Lung Transplantation Scientific Statement on pulmonary antibody-mediated rejection and proposed graft, antibody, and pathology (GAP) definition.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026Guideline
- Circulating donor-derived cell-free DNA as a marker for rejection after lung transplantation.Frontiers in immunology · 2023Pooled it
- Apparentness of Unseen Rejection Episodes Post Lung rLTx Is Reliably Enabled by ddcfDNA Detection.HLA · 2026Article
- Utility of donor-derived cell-free DNA testing after lung transplantation in the precision medicine era.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026Review
- Comparison of donor-derived cell-free DNA fractions between combined heart-lung vs isolated heart or lung transplant recipients.JHLT open · 2026Article
- ERS Congress 2025: highlights from the Thoracic Surgery and Lung Transplantation Assembly.ERJ open research · 2026Article
- Donor-derived cell-free DNA associated with increased risk of chronic lung allograft dysfunction and mortality: Are absolute levels better than percentage?The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026Observational
- Exploring acute cellular rejection in lung transplantation: insights from donor-derived cell-free DNA analysis.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia · 2026Article
- Exploring acute cellular rejection in lung transplantation: insights from donor-derived cell-free DNA analysis.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia · 2026Article
- Correlation between acute cellular rejection detected with cryobiopsy and elevated donor-derived cell-free DNA in lung transplant recipients.JHLT open · 2026Article
- Surveillance Donor-derived Cell-free DNA Allows for the Safe Reduction in Protocol Transbronchial Biopsies After Lung Transplantation.Transplantation direct · 2026Article
- Correlation between acute cellular rejection detected with cryobiopsy and elevated dd-cfDNA in lung transplant recipients.JHLT open · 2026Article
- Lung allograft injury improves after gastroesophageal reflux surgery by donor-derived cell-free DNA kinetics.Frontiers in medicine · 2026Article
- Plasma Cell-free DNA Associated With Risk of Mortality and Chronic Lung Allograft Dysfunction Among Lung Transplant Recipients WithTransplantation direct · 2026Article
- Donor-derived cell-free DNA testing for noninvasive monitoring of allograft rejection after lung transplantation.Frontiers in immunology · 2026Article
- Advances in donor-derived cell-free DNA monitoring for solid organ transplantation.Frontiers in immunology · 2026Review
- Development and validation of a bronchoalveolar lavage genomic classifier for acute cellular rejection.EBioMedicine · 2025Article
- A Prospective Pilot Study to Investigate Whether Donor-Derived Cell-Free DNA Can Be Used as a Biomarker of Recurrent IgA Nephropathy Post-Kidney Transplantation.International journal of immunogenetics · 2025Article
- Molecular criteria for pulmonary antibody-mediated rejection are associated with an increased risk of allograft failure.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2025Observational
- Donor-derived cell-free DNA in solid organ transplantation: analytical considerations, diagnostic performance, and clinical interpretation.Clinical transplantation and research · 2025Review
Corrections and comments
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Authors and funding
17 authors at 9 institutions in 1 country.
Funding
Abstract
backgroundAcute rejection, which includes antibody-mediated rejection and acute cellular rejection, is a risk factor for lung allograft loss. Lung transplant patients often undergo surveillance transbronchial biopsies to detect and treat acute rejection before irreversible chronic rejection develops. Limitations of this approach include its invasiveness and high interobserver variability. We tested the performance of percent donor-derived cell-free DNA (%ddcfDNA), a non-invasive blood test, to detect acute rejection.
methodsThis multicenter cohort study monitored 148 lung transplant subjects over a median of 19.6 months. We collected serial plasma samples contemporaneously with TBBx to measure %ddcfDNA. Clinical data was collected to adjudicate for acute rejection. The primary analysis consisted of computing the area-under-the-receiver-operating-characteristic-curve of %ddcfDNA to detect acute rejection. Secondary analysis determined %ddcfDNA rule-out thresholds for acute rejection.
resultsddcfDNA levels were high after transplant surgery and decayed logarithmically. With acute rejection, ddcfDNA levels rose six-fold higher than controls. ddcfDNA levels also correlated with severity of lung function decline and histological grading of rejection. %ddcfDNA area-under-the-receiver-operating-characteristic-curve for acute rejection, AMR, and ACR were 0.89, 0.93, and 0.83, respectively. ddcfDNA levels of <0.5% and <1.0% showed a negative predictive value of 96% and 90% for acute rejection, respectively. Histopathology detected one-third of episodes with ddcfDNA levels ≥1.0%, even though >90% of these events were coincident to clinical complications missed by histopathology.
conclusionsThis study demonstrates that %ddcfDNA reliably detects acute rejection and other clinical complications potentially missed by histopathology, lending support to its use as a non-invasive marker of allograft injury.
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