Evidence map›Paper›PMID 40744691›Full record

ArticleThe European respiratory journal2026

Early post-transplant recipient tissue injury predicts allograft function, rejection and survival in lung transplant recipients: evidence from cell-free DNA.

Muhtadi Alnababteh, Michael B Keller, Hyesik Kong, Kellie Phipps, Jackson Namian, Lucia Ponor, Pali Shah, Joby Mathews, Temesgen Andargie, Woojin Park and 9 more

2 registry-linked trialsAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The European respiratory journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02423070 recruitingnot on this map

Genome Transplant Dynamics

TypeobservationalSponsorNational Heart, Lung, and Blood Institute (NHLBI)Ran2015 to 2034Enrolled991ConditionsThoracic Organ Transplantation
NCT07516379 recruitingnot on this map

GRAfT 2.0. A Multimodal Prospective Approach to Define the Mechanisms and Clinical Features of Acute and Chronic Rejection in Lung Transplantation

TypeobservationalSponsorNational Heart, Lung, and Blood Institute (NHLBI)Ran2026 to 2032Enrolled100ConditionsLung Transplant, End Stage Lung Disease, Rejection
3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. 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 · 2026
    Review
  2. Article
  3. Article
  4. 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 · 2026
    Observational
  5. Article
  6. %dd-cfDNA: The New Frontier for Heart/Lung Transplant Surveillance?Transplant international : official journal of the European Society for Organ Transplantation · 2025
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors.

Muhtadi AlnababtehLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Michael B KellerGenomic Research Alliance for Transplantation (GRAfT), USA.
Hyesik KongLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Kellie PhippsLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Jackson NamianLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Lucia PonorDivision of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Pali ShahGenomic Research Alliance for Transplantation (GRAfT), USA.
Joby MathewsGenomic Research Alliance for Transplantation (GRAfT), USA.
Temesgen AndargieLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Woojin ParkLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Jonathan B OrensPulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Shambhu AryalGenomic Research Alliance for Transplantation (GRAfT), USA.
Steven D NathanGenomic Research Alliance for Transplantation (GRAfT), USA.ORCID https://orcid.org/0000-0002-6270-1617
Errol BushDivision of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neelam RedekarLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Tom HillLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Moon JangLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Xin TianOffice of Biostatistics Research, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.
Sean Agbor-EnohLaboratory of Applied Precision Omics (APO), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA.

Funding

Use of donor-derived cell-free DNA for risk stratification and post-treatment monitoring of lung transplant patients at risk for chronic lung allograft dysfunctionK22HL166368 · NHLBI · UNIVERSITY OF MARYLAND BALTIMORE · PI Michael Keller · 2025 to 2026
$498k
NHLBI NIH HHS K22 HL166368
6 · The paper itself

Abstract

backgroundAllograft injury in the early post-transplant period is a known risk factor of death after lung transplantation. However, the recipient tissue injury profile and its association with outcomes remain unexplored. This study leverages cell-free DNA (cfDNA) to test this association.

methodsThe prospective cohort multicentre study included lung transplant recipients (GRAfT; ClinicalTrials.gov: NCT02423070) with serial plasma measurements of recipient-derived (rd)-cfDNA using digital droplet PCR. Non-transplant healthy controls were recruited as the comparator. Whole-genome bisulfite sequencing identified tissue sources of cfDNA. Mean rd-cfDNA levels within 30 days post-transplant were computed. Multivariable regression models were used to assess the association between rd-cfDNA tertiles and the primary outcome (death) and secondary outcomes.

resultsThe study included 215 patients with 2530 cfDNA values, including 675 cfDNA assessments in the first 30 days. Median rd-cfDNA levels in the first 30 days post-transplant were ∼16-fold higher than cfDNA for healthy controls. Patients in the highest tertile rd-cfDNA group had lower lung function post-transplant, and increased risk of death (hazard ratio (HR) 3.15, 95% CI 1.59-6.24; p<0.001) and acute rejection (HR 2.33, 95% CI 1.33-4.08; p=0.03) compared to the low/middle tertile group. Tissue-specific cfDNA sources were distinct in the highest

conclusionPost-transplant recipient tissue injury varies between lung transplant patients, and is associated with increased risk of acute rejection and mortality.

Indexed as

Cell-Free Nucleic AcidsGraft RejectionLung TransplantationAdultAgedAllograftsFemaleHumansMaleMiddle AgedProspective StudiesRisk FactorsTransplant RecipientsCell-Free Nucleic Acids

Identifiers

PMID40744691
PMCPMC13084303

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.