Heart failure & cardiomyopathiesCohort study
Donor-Derived Cell-Free DNA at Diagnosis of Cardiac Allograft Rejection Stratifies Risk of Mortality and Graft Dysfunction
- prospective multicenter GRAfT study
Authors' conclusion
AR with elevated %dd-cfDNA levels at diagnosis is associated with an increased risk of adverse outcomes after heart transplant, offering novel prognostic utility.
Study context
- Population
- Heart transplant recipients3,218 %dd-cfDNA measurements
- Participants
- 277 recipients
- Exposure
- Acute rejection (AR) stratified by %dd-cfDNA at diagnosis vs patients who had not developed AR at the same follow-up time
- ARn = 75
- Outcome
- Composite of:
- Death
- Prolonged LV dysfunction (LV ejection fraction ≤50% for ≥90 days)
- Follow-up
- Median 4.9 years
Main finding
As reported in the abstract
Each group vs no ARHazard ratio (95% CI)P value
AR
4.47(2.42–8.26)
P < 0.001AR with %dd-cfDNA ≥0.15%composite outcome
6.28(3.04–13.0)
P < 0.001Observational data: associations, not effects.
Further findings
Event counts · median follow-up of 4.9 years (interquartile range, 2.5-5.0)
- Composite outcome of death or prolonged left ventricular (LV) dysfunction
- 53 patients
- Developed AR
- 75 (27%)
- Acute cellular rejection
- 43 (15%)
- Pathological antibody-mediated rejection
- 18 (7%)
- Donor-specific antibody+/LV dysfunction
- 14 (5%)
Original publication
Donor-Derived Cell-Free DNA at Diagnosis of Cardiac Allograft Rejection Stratifies Risk of Mortality and Graft Dysfunction. Circ Heart Fail. Published 15 June 2026. doi:10.1161/circheartfailure.125.013718
Summarised from the published abstract; every number is checked against it