Risk stratification by donor-derived cell-free DNA: a three-year single center study of kidney transplant outcomes from 257 patients

Elevated dd-cfDNA levels were associated with adverse alloimmune and functional outcomes, including rejection, DSA positivity, and reduced graft survival (p=0.0071). A logistic regression model identified eGFR decline in the >1.0% group to predict long-term graft failure and patient survival (p=0.04). These findings support the clinical value of dd-cfDNA as a biomarker of alloimmune risk in kidney transplant recipients.