Journals / New Trends in Medicine Sciences / 2026 / Volume: 7 Issue: 2

Donor-Derived Cell-Free DNA in Solid Organ Transplantation: An Evidence-Based Review

Mahmut Aktğrk(ATATÜRK ÜNİVERSİTESİ)0000-0003-0200-4577
Eda Balkan(ATATÜRK ÜNİVERSİTESİ)0000-0002-7065-8161
Necip Altundaş(ATATÜRK ÜNİVERSİTESİ)0000-0002-5165-638X
Murat Kızılkaya(AGRI IBRAHIM CECEN UNIVERSITY)0009-0001-0567-2813
Pages
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Publication Date
2026-06-30
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

This review aims to address the biological foundations of dd-cfDNA, its measurement methodologies, organ-specific experimental and clinical data, as well as its current limitations and future perspectives.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Abstract Donor-derived cell-free DNA (dd-cfDNA) refers to DNA fragments originating from the transplanted organ tissue that are detected in the recipient's circulation as products of cellular degradation.
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Key Findings & Data:In recent years, dd-cfDNA has emerged as a compelling biomarker for immune monitoring and early diagnosis of rejection in solid organ transplantation—particularly in kidney, heart, lung, and liver transplants—due to its potential to provide earlier and more sensitive signals compared to conventional biomarkers.
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Conclusion & Impact:This review aims to address the biological foundations of dd-cfDNA, its measurement methodologies, organ-specific experimental and clinical data, as well as its current limitations and future perspectives.
🔬Design:Review & Systematic Survey
📍Scope:Comprehensive Sample
⚙️Variables:cfDNA · Transplanttaıon · genes

Abstract

Abstract Donor-derived cell-free DNA (dd-cfDNA) refers to DNA fragments originating from the transplanted organ tissue that are detected in the recipient's circulation as products of cellular degradation. In recent years, dd-cfDNA has emerged as a compelling biomarker for immune monitoring and early diagnosis of rejection in solid organ transplantation—particularly in kidney, heart, lung, and liver transplants—due to its potential to provide earlier and more sensitive signals compared to conventional biomarkers. This review aims to address the biological foundations of dd-cfDNA, its measurement methodologies, organ-specific experimental and clinical data, as well as its current limitations and future perspectives.

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Cite This Article

Aktğrk, M., Balkan, E., Altundaş, N., Kızılkaya, M. (2026). Donor-Derived Cell-Free DNA in Solid Organ Transplantation: An Evidence-Based Review. New Trends in Medicine Sciences, Volume: 7 Issue: 2. https://doi.org/10.56766/ntms.1852728

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References (62)

  1. Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21st century. Ann Transl Med. 2018;6(20):409.
  2. Hariharan S, Israni AK, Danovitch G. Long-term survival after kidney transplantation. New Eng J Med. 2021;385(8):729-43.
  3. Jevnikar AM, Mannon RB. Late kidney allograft loss: what we know about it, and what we can do about it. Cl J Am Soc Nephrol. 2008;3(Supplement-2):S56-S67.
  4. Zorn E, See SB. Polyreactive natural antibodies in transplantation. Curr Opinion Organ transplantat. 2017;22(1):8-13.
  5. Josephson MA. Monitoring and managing graft health in the kidney transplant recipient. Clin J the Am Socf Nephrol. 2011;6(7):1774-80.
  6. Germani G, Rodriguez-Castro K, Russo FP, et al. Markers of acute rejection and graft acceptance in liver transplantation. World journal of gastroenterology: WJG. 2015;21(4):1061.
  7. Oellerich M, Budde K, Osmanodja B, et al. Donor-derived cell-free DNA as a diagnostic tool in transplantation. Front Genet. 2022;13:1031894.
  8. Baraldi-Junkins C, Levin H, Kasper E, Rayburn B, Herskowitz A, Baughman K. Complications of endomyocardial biopsy in heart transplant patients. JHLT. 1993;12(1 Pt 1):63-67.
  9. Oellerich M, Shipkova M, Asendorf T, et al. Absolute quantification of donor-derived cell-free DNA as a marker of rejection and graft injury in kidney transplantation: Results from a prospective observational study. Am J Transplant. 2019;19(11):3087-99.
  10. Schwarz A, Gwinner W, Hiss M, Radermacher J, Mengel M, Haller H. Safety and adequacy of renal transplant protocol biopsies. Am J Transplant 2005;5(8):1992-96.
  11. Kim HD, Bae H, Kang H, et al. Donor-derived cell-free DNA predicted allograft rejection and severe microvascular inflammation in kidney transplant recipients. Front Immunol. 2024;15:1433918.
  12. Grabuschnig S, Bronkhorst AJ, Holdenrieder S, et al. Putative origins of cell-free DNA in humans: a review of active and passive nucleic acid release mechanisms. Int J Mol Sci. 2020;21(21):8062.
  13. Bloom RD, Bromberg JS, Poggio ED, et al. Cell-free DNA and active rejection in kidney allografts. J Am Soc Nephrol. 2017;28(7):2221-2232.
  14. Jang MK, Tunc I, Berry GJ, et al. Donor-derived cell-free DNA accurately detects acute rejection in lung transplant patients, a multicenter cohort study. JHLT. 2021;40(8):822-30.
  15. Kim PJ, Olymbios M, Siu A, et al. A novel donor-derived cell-free DNA assay for the detection of acute rejection in heart transplantation. JHLT. 2022;41(7):919-927.
  16. Levitsky J, Kandpal M, Guo K, Kleiboeker S, Sinha R, Abecassis M. Donor-derived cell-free DNA levels predict graft injury in liver transplant recipients. Am J Transplant. 2022;22(2):532-540.
  17. Donor-Derived Cell-free DNA: an Established Biomarker for Allograft Injury. https://caredx.com/products-and-services/transplant-lab-products/post-transplant-surveillance/alloseq-cfdna/.
  18. Huang E, Sethi S, Peng A, et al. Early clinical experience using donor-derived cell-free DNA to detect rejection in kidney transplant recipients. Am J Transplant. 2019;19(6):1663-70.
  19. Khush KK, Patel J, Pinney S, et al. Noninvasive detection of graft injury after heart transplant using donor-derived cell-free DNA: a prospective multicenter study. Am J Transplant. 2019;19(10):2889-99.
  20. Cao C, Yuan L, Wang Y, et al. Analysis of the primary factors influencing donor derived cell-free DNA testing in kidney transplantation. Front Immunol. 2024;15:1435578.
  21. Clausen FB, Jørgensen KMCL, Wardil LW, Nielsen LK, Krog GR. Droplet digital PCR-based testing for donor-derived cell-free DNA in transplanted patients as noninvasive marker of allograft health: Methodological aspects. PLoS One. 2023;18(2):e0282332.
  22. Zhong Y, Hu X, Li X, et al. Advances and challenges in the application of donor-derived cell-free DNA for diagnosis and treatment in liver transplantation: a narrative review. BMC Surgery. 2025;25(1):203.
  23. Alansari H, Gorthi JR. Rejection Surveillance: Integrating Cell-Free DNA and Gene Expression Panels to Decrease Invasiveness in Routine Monitoring of Heart Transplant Recipients. Methodist DeBakey Cardiovasc J. 2025;21(3):51.
  24. Schütz E, Asendorf T, Beck J, et al. Time-dependent apparent increase in dd-cfDNA percentage in clinically stable patients between one and five years following kidney transplantation. Clin Chem. 2020;66(10):1290-99.
  25. Davidson BA, Miranda AX, Reed SC, et al. An in vitro CRISPR screen of cell-free DNA identifies apoptosis as the primary mediator of cell-free DNA release. Commun Biol. 2024;7(1):441.
  26. Edwards RL, Menteer J, Lestz RM, Baxter-Lowe LA. Cell-free DNA as a solid-organ transplant biomarker: technologies and approaches. Biomark Med. 2022;16(5):401-415.
  27. Sun K, Jiang P, Chan KA, et al. Plasma DNA tissue mapping by genome-wide methylation sequencing for noninvasive prenatal, cancer, and transplantation assessments. Proc Natl Acad Sci. 2015;112(40):E5503-E5512.
  28. Neuberger EW, Sontag S, Brahmer A, et al. Physical activity specifically evokes release of cell-free DNA from granulocytes thereby affecting liquid biopsy. Clin Epigenetics. 2022;14(1):29.
  29. Oellerich M, Sherwood K, Keown P, et al. Liquid biopsies: donor-derived cell-free DNA for the detection of kidney allograft injury. Nat Rev Nephrol. 2021;17(9):591-603.
  30. Bu L, Gupta G, Pai A, et al. Clinical outcomes from the Assessing Donor-derived cell-free DNA Monitoring Insights of kidney Allografts with Longitudinal surveillance (ADMIRAL) study. Kidney Int. 2022;101(4):793-803.
  31. Wang W, Haider CG, Wang Y, et al. Donor-derived cell-free DNA-based liquid biopsies to determine future kidney transplant rejection. Kidney Res Clin Pract. 2025;44(5):705-25.
  32. Schütz E, Fischer A, Beck J, et al. Graft-derived cell-free DNA, a noninvasive early rejection and graft damage marker in liver transplantation: a prospective, observational, multicenter cohort study. PLoS Med. 2017;14(4):e1002286.
  33. Nakamura K, Kageyama S, Kupiec-Weglinski JW. Innate immunity in ischemia-reperfusion injury and graft rejection. Current Opin Organ Transplant. 2019;24(6):687-93.
  34. Turabi K, Klute K, Radhakrishnan P. Decoding the dynamics of circulating tumor DNA in liquid biopsies. Cancers. 2024;16(13):2432.
  35. dd-cfDNA Provides a Real-Time Assessment of Allograft Status. https://caredx.com/products-and-services/transplant-lab-products/post-transplant-surveillance/alloseq-cfdna/.
  36. Lui YY, Woo K-S, Wang AY, et al. Origin of plasma cell-free DNA after solid organ transplantation. Clin Chem. 2003;49(3):495-96.
  37. Gadi VK, Nelson JL, Boespflug ND, Guthrie KA, Kuhr CS. Soluble donor DNA concentrations in recipient serum correlate with pancreas-kidney rejection. Clinical Chem. 2006;52(3):379-82.
  38. Dauber EM, Kollmann D, Kozakowski N, et al. Quantitative PCR of INDEL s to measure donor‐derived cell‐free DNA-a potential method to detect acute rejection in kidney transplantation: a pilot study. Transpl Int. 2020;33(3):298-309.
  39. Richmond ME, Zangwill SD, Kindel SJ, et al. Donor fraction cell-free DNA and rejection in adult and pediatric heart transplantation. The J H LT. 2020;39(5):454-63.
  40. Adamek M, Opelz G, Klein K, Morath C, Tran TH. A fast and simple method for detecting and quantifying donor-derived cell-free DNA in sera of solid organ transplant recipients as a biomarker for graft function. Clin Chem Lab Med (CCLM). 2016;54(7):1147-55.
  41. Martuszewski A, Paluszkiewicz P, Król M, Banasik M, Kepinska M. Donor-derived cell-free DNA in kidney transplantation as a potential rejection biomarker: a systematic literature review. J Clin Med. 2021;10(2):193.
  42. Cirmena G, Dameri M, Ravera F, Fregatti P, Ballestrero A, Zoppoli G. Assessment of circulating nucleic acids in cancer: From current status to future perspectives and potential clinical applications. Cancers. 2021;13(14):3460.
  43. Raszeja-Wyszomirska J, Macech M, Kolanowska M, et al. Free-circulating nucleic acids as biomarkers in patients after solid organ transplantation. Ann Transplant. 2023;28:e939750-939751.
  44. Böhmer J, Wasslavik C, Andersson D, et al. Absolute quantification of donor-derived cell-free DNA in pediatric and adult patients after heart transplantation: a prospective study. Transplant Int. 2023;36:11260.
  45. Zou J, Duffy B, Slade M, et al. Rapid detection of donor cell free DNA in lung transplant recipients with rejections using donor-recipient HLA mismatch. Human Immunol. 2017;78(4):342-49.
  46. Whitlam JB, Ling L, Skene A, et al. Diagnostic application of kidney allograft-derived absolute cell-free DNA levels during transplant dysfunction. Am J Transplant. 2019;19(4):1037-49.
  47. Zhang W, Liu B, Jia D, et al. Application of graft-derived cell-free DNA for solid organ transplantation. Front Immunol. 2024;15:1461480.
  48. Roberts R. The Basics and Applications of Cell-Free DNA. In:2023.
  49. Zhang H, Zheng C, Li X, et al. Diagnostic performance of donor-derived plasma cell-free DNA fraction for antibody-mediated rejection in post renal transplant recipients: a prospective observational study. Front Immunol. 2020;11:342.
  50. Sigdel TK, Archila FA, Constantin T, et al. Optimizing detection of kidney transplant injury by assessment of donor-derived cell-free DNA via massively multiplex PCR. J Clin Med. 2018;8(1):19.
  51. Bromberg JS, Bunnapradist S, Samaniego-Picota M, et al. Elevation of donor-derived cell-free DNA before biopsy-proven rejection in kidney transplant. Transplantation. 2024;108(9):1994-2004.
  52. Truby LK, Maamari D, Saha A, et al. Towards allograft longevity: leveraging omics technologies to improve heart transplant outcomes. Curr Heart Fail Rep. 2023;20(6):493-503.
  53. Baumann AK, Beck J, Kirchner T, et al. Elevated fractional donor‐derived cell‐free DNA during subclinical graft injury after liver transplantation. Liver Transplant. 2022;28(12):1911-19.
  54. Avramidou E, Vasileiadou S, Antoniadis N, et al. Liver transplantation and dd-cfDNA: A small solution for a big problem. Livers. 2023;3(1):76-81.
  55. Rosenheck JP, Ross DJ, Botros M, et al. Clinical validation of a plasma donor-derived cell-free DNA assay to detect allograft rejection and injury in lung transplant. Transplant Direct. 2022;8(4):e1317.
  56. De Vlaminck I, Martin L, Kertesz M, et al. Noninvasive monitoring of infection and rejection after lung transplantation. Proc Natl Acad Sci. 2015;112(43):13336-13341.
  57. Sayah D, Weigt SS, Ramsey A, Ardehali A, Golden J, Ross DJ. Plasma donor-derived cell-free DNA levels are increased during acute cellular rejection after lung transplant: pilot data. Transplant Direct. 2020;6(10):e608.
  58. Elevated dd-cfDNA levels, which serve as a leading indicator of lung graft damage, are measurable. https://caredx.com/products-and-services/transplant-services/lung/.
  59. Van Rijn A, Roos R, Dekker F, Rotmans J, Feltkamp M. Torque teno virus load as marker of rejection and infection in solid organ transplantation–A systematic review and meta‐analysis. Rev Med Virol. 2023;33(1):e2393.
  60. Ju C, Wang L, Xu P, et al. Differentiation between lung allograft rejection and infection using donor-derived cell-free DNA and pathogen detection by metagenomic next-generation sequencing. Heliyon. 2023;9(11).
  61. Sinha R, Zhu Z, Park S, et al. Combined metagenomic viral detection and donor-derived cell-free DNA quantification in plasma from kidney transplant recipients. Transplantation Proc. 2024; 56(6):1522-30.
  62. Josephson MA. Monitoring and managing graft health in the kidney transplant recipient. Clin J the Am Socf Nephrol. 2011;6(7):1774-80.