{
  "abstract": "Endomyocardial biopsy (EMB) is the gold standard for diagnosing post-heart transplant acute rejection (AR) but is invasive. Donor-derived cell-free DNA (dd-cfDNA) is a promising noninvasive biomarker, yet thresholds for Asian recipients remain undefined. This prospective study enrolled 80 patients, with 299 dd-cfDNA specimens analyzed via a novel Chinese-developed next-generation sequencing assay targeting 48 Indel sites. A reference cohort (n = 42) established post-transplant dd-cfDNA kinetics, while a biopsy cohort (n = 41, 18 acute cellular rejection [ACR], 9 antibody-mediated rejection [AMR], 14 no rejection [NR]) paired with EMB evaluated diagnostic performance. dd-cfDNA peaked at week 1, with a stable trend emerging from week 4 and stable levels reached by week 8. AR patients had significantly higher dd-cfDNA levels than NR patients (0.87% vs. 0.23%, P < 0.001). The optimal composite AR threshold was 0.33% (AUC = 0.874, sensitivity 81.0%, specificity 85.7%). dd-cfDNA decreased post-therapy (P = 0.011) and showed an inverse association with left ventricular ejection fraction (LVEF) (P = 0.004). This study provides initial evidence for an assay- and cohort-specific dd-cfDNA threshold (0.33%) for AR detection in Chinese recipients. Given the modest NPV (75.0%), this threshold is better suited for a \"rule-in\" strategy, and low values should not be used in isolation to defer biopsy. External validation in multicenter cohorts is required before routine clinical implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Shanshan Zheng"
    },
    {
      "affs": [
        0
      ],
      "name": "Sheng Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhiyuan Zhu"
    },
    {
      "affs": [
        0
      ],
      "name": "Jie Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhongkai Liao"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhe Zheng"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaonan Fang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lin Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Hang Xu"
    },
    {
      "affs": [
        0
      ],
      "name": "Jiexu Ma"
    },
    {
      "affs": [
        0
      ],
      "name": "Yige Huyan"
    },
    {
      "affs": [
        0
      ],
      "name": "Xinhe Xu"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhengbang Zou"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6my1w71cd6qfv.bib",
  "cited_by": 0,
  "doi": "10.3389/ti.2026.16415",
  "fulltext_url": "https://europepmc.org/articles/PMC13677294",
  "id": "6my1w71cd6qfv",
  "issns": [
    "0934-0874",
    "1432-2277"
  ],
  "landing_url": "https://europepmc.org/article/MED/42898121",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Transplantation: Methods and Outcomes"
    ]
  ],
  "openalex": "W7219698689",
  "pdf_url": "https://europepmc.org/articles/PMC13677294?pdf=render",
  "pmcid": "PMC13677294",
  "pmid": "42898121",
  "published": "2026-10-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/6my1w71cd6qfv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:37Z",
      "native_id": "MED:42898121",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42898121"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Transplantation: Methods and Outcomes",
      "subfield": "surgery"
    }
  ],
  "title": "Prospective evaluation of donor-derived cell-free DNA for noninvasive detection of acute rejection in an Asian heart transplant population.",
  "title_text": "Prospective evaluation of donor-derived cell-free DNA for noninvasive detection of acute rejection in an Asian heart transplant population.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:37Z",
  "url": "https://research.draconitic.com/paper/6my1w71cd6qfv",
  "venue": "Transplant international : official journal of the European Society for Organ Transplantation",
  "versions": []
}