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Longitudinal monitoring of donor-derived cell-free DNA supports risk stratification in kidney transplant recipients with allograft dysfunction

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 an...

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Main Authors: Schröter, Iris (Author) , Loi, Lisa (Author) , Reineke, Marvin (Author) , Rudek, Markus (Author) , Nußhag, Christian (Author) , Kälble, Florian (Author) , Speer, Claudius (Author) , Zeier, Martin (Author) , Tran, Thuong Hien (Author) , Morath, Christian (Author) , Benning, Louise (Author)
Format: Article (Journal)
Language:English
Published: March 2026
In: Transplant international
Year: 2026, Volume: 39, Pages: 1-13
ISSN:1432-2277
DOI:10.3389/ti.2026.15929
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.3389/ti.2026.15929
Verlag, kostenfrei, Volltext: https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.15929/full
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Author Notes:Iris Schröter, Lisa Loi, Marvin Reineke, Markus Rudek, Christian Nusshag, Florian Kälble, Claudius Speer, Martin Zeier, Thuong Hien Tran, Christian Morath and Louise Benning
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Summary: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 days thereafter. dd-cfDNA was analyzed as a continuous, threshold-based, and longitudinal time-dependent variable. Clinical endpoints included ≥30% eGFR decline within 2 years, indication for re-biopsy, and graft failure. Persistent elevation of dd-cfDNA (≥0.5% at 90 days) occurred in 7.4% of patients, with 50% requiring re-biopsy and 37.5% developing graft failure. A single measurement ≥1.0% significantly predicted ≥30% eGFR decline (HR 2.28; 95% CI 1.03-5.05), whereas levels ≥0.5% 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 ≥30% eGFR decline (HR 1.68; 95% CI 1.12-2.51), re-biopsy (HR 1.88; 95% CI 1.38-2.55), and graft failure (HR 3.42; 95% CI 2.00-5.86). 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.
Item Description:Veröffentlicht: 12. März 2026
Gesehen am 24.04.2026
Physical Description:Online Resource
ISSN:1432-2277
DOI:10.3389/ti.2026.15929

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