ArticleFrontiers in medicine2026
Real-world utilization patterns and association of dd-cfDNA with biopsy and rejection.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
Background: Donor-derived cell-free DNA (dd-cfDNA) is a noninvasive biomarker for allograft injury in kidney transplant recipients. This single-center study aimed to evaluate the clinical indications for dd-cfDNA testing, its association with biopsy findings, and the comparative utility of dd-cfDNA expressed as a percentage versus absolute copy number. Methods: A retrospective analysis was conducted of 571 dd-cfDNA measurements from 313 kidney transplant recipients at the Charité Berlin Transplant Center from May 2020 to May 2025. The clinical indications for testing, biopsy, and rejection predictors were assessed using multivariable logistic regression and linear regression. Results: Elevated creatinine (29%), elevated urine albumin-to-creatinine ratio (UACR, 10%), donor-specific antibody positivity (10%), history of rejection (9%), immunosuppression reduction (5%), and combined reasons (38%) were the most frequent indications for dd-cfDNA testing. Elevated UACR was the only independent predictor of biopsy (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.39-6.58; Conclusion: Although biopsy decisions primarily rely on conventional clinical parameters, dd-cfDNA can independently identify rejection and improve decision-making when integrated into multimodal post-transplant monitoring strategies.
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