ArticleFrontiers in immunology2026
Donor-derived cell-free DNA testing for noninvasive monitoring of allograft rejection after lung transplantation.
Article in Frontiers in immunology, 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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Abstract
Background: Donor-derived cell-free DNA (dd-cfDNA) is a promising noninvasive marker of graft injury after lung transplantation (LTx), but its real-world value for identifying rejection-associated allograft injury and its interpretation across infection status and transplant procedures remain uncertain. Methods: This single-center retrospective study consecutively included LTx recipients undergoing inpatient follow-up and dd-cfDNA testing from February 2024 to March 2026. Analyses used observations obtained ≥1 month after LTx. Diagnostic performance was assessed by ROC analysis, and the association between dd-cfDNA (%) and clinically diagnosed rejection was evaluated by multivariable logistic regression. Single- and double-LTx recipients were compared, and a stable-state correction factor was explored. Results: Among 161 recipients, 218 dd-cfDNA tests were performed; 196 non-perioperative observations were analyzed, including 64 rejection and 132 non-rejection observations. Both dd-cfDNA (%) and dd-cfDNA (copies/mL) were higher in rejection. dd-cfDNA (%) yielded an AUC of 0.677 (95% CI, 0.600-0.755), with a cutoff of 1.03% (sensitivity, 90.6%; specificity, 40.9%). dd-cfDNA (copies/mL) yielded an AUC of 0.666 (95% CI, 0.584-0.748), with a cutoff of 104.10 copies/mL (sensitivity, 48.4%; specificity, 78.8%). dd-cfDNA (%) remained independently associated with rejection (adjusted OR, 1.36; 95% CI, 1.15-1.62; P<0.001). Single-LTx recipients had lower dd-cfDNA (%) than double-LTx recipients under stable and rejection conditions; this difference was attenuated after correction (CF = 1.54). Conclusions: dd-cfDNA may serve as a noninvasive adjunct for identifying rejection-associated allograft injury after LTx. Infection and transplant procedure should be considered during interpretation, and stable-state correction may improve comparability between single- and double-LTx recipients.
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