Heart failure & cardiomyopathiesCohort study
Donor-Derived Cell-Free DNA in Antibody-Mediated Rejection
- Registry-based cohort study
Authors' conclusion
The authors document significant context dependent variability of AMR incidence and the utility of dd-cfDNA in predicting biopsy yield.
Study context
- Population
- Heart transplant recipients in the SHORE registry transplanted 2017–2022 with verified biopsy, Donor-derived cell-free DNA (dd-cfDNA), echocardiographic and donor-specific antibody (DSA) data
- Participants
- 2,240 recipients
- Exposure
- Antibody-mediated rejection (AMR) incidence by clinical context and dd-cfDNA level
- Outcome
- Incidence and timing of biopsy-proven AMR; performance characteristics of dd-cfDNA for AMR
Main finding
As reported in the abstract
Biopsy-proven AMR
AMR in all biopsies
2.6%
AMR, normal graft function and no DSAs
1.1%
AMR, known DSA and graft dysfunction
20.4%
Observational data: associations, not effects.
Further findings
AMR incidence by dd-cfDNA level, no DSA and no graft dysfunction
- dd-cfDNA <0.20%
- 0.7%
- dd-cfDNA 0.20%–0.49%
- 1.2%
- dd-cfDNA ≥0.50%
- 6.7%
AMR incidence by dd-cfDNA level, known DSA but no graft dysfunction
- dd-cfDNA <0.20%
- 1.4%
- dd-cfDNA 0.20%–0.49%
- 4.8%
- dd-cfDNA ≥0.50%
- 15.5%
Original publication
Donor-Derived Cell-Free DNA in Antibody-Mediated Rejection. JACC Heart Fail. Published 22 October 2025. doi:10.1016/j.jchf.2025.102716
Summarised from the published abstract; every number is checked against it