Heart failure & cardiomyopathies
Significance of Elevated Donor-Derived Cell-Free DNA in Heart Transplant Recipients With Negative Endomyocardial Biopsies: A Dawn of a New Era
Authors' conclusion
In our cohort, patients with positive dd-cfDNA levels and negative biopsy results had higher rates of adverse outcomes, including graft dysfunction and mortality.
Study context
- Population
- Heart transplant recipients, 2019–2023, excluding multiorgan transplants; Donor-derived cell-free DNA (dd-cfDNA) samples paired with endomyocardial biopsy (<30 days)643 dd-cfDNA samples
- Participants
- 227 recipients
- Exposure
- Positive dd-cfDNA with negative endomyocardial biopsy vs negative dd-cfDNA
- Outcome
- Mortality and graft dysfunction (EF<50%)
Methodological detailsconsecutive patients, mixed model Cox regression
- Consecutive patients
- Mixed model Cox regression
Main finding
As reported in the abstract
Mortality and graft dysfunction, dd-cfDNA ≥0.20%
dd-cfDNA positive vs Negative dd-cfDNAHazard ratio (95% CI)P value
Mortality; dd-cfDNA ≥ 0.20%
4.6(1.6–13.4)
P = 0.005Graft dysfunction; dd-cfDNA ≥ 0.20%
3.4(1.0–11.9)
P = 0.054Observational data: associations, not effects.
Further findings
| Outcome | dd-cfDNA positive | dd-cfDNA ≥0.20% | Negative dd-cfDNA | P value | |
|---|---|---|---|---|---|
| Positive dd-cfDNA with negative biopsy · samples | 37% | ||||
| Patients | 110 | Not reported in the abstract | Not reported in the abstract | dd-cfDNA ≥0.20%, Negative dd-cfDNA: not reported in the abstract | |
| Median dd-cfDNA level | 0.24% (IQR 0.16%-0.53%) | Not reported in the abstract | Not reported in the abstract | dd-cfDNA ≥0.20%, Negative dd-cfDNA: not reported in the abstract | |
| Exceeding 0.20% | 63% | Not reported in the abstract | Not reported in the abstract | dd-cfDNA ≥0.20%, Negative dd-cfDNA: not reported in the abstract | |
| Prior treated antibody-mediated rejection | 15% | Not reported in the abstract | 5% | P = 0.002 | dd-cfDNA ≥0.20%: not reported in the abstract |
Original publication
Significance of Elevated Donor-Derived Cell-Free DNA in Heart Transplant Recipients With Negative Endomyocardial Biopsies: A Dawn of a New Era. Circ Heart Fail. Published 30 September 2025. doi:10.
Summarised from the published abstract; every number is checked against it