Donor-derived, cell-free DNA levels by next-generation targeted sequencing are elevated in allograft rejection after lung transplantation.

Our principal findings are as follows: (1) dd-cfDNA level was elevated in ACR (median 0.91%; interquartile range (IQR): 0.39–2.07%), CLAD (2.06%; IQR: 0.57–3.67%) and an aggregated cohort of rejection encompassing allograft injury (1.06%; IQR: 0.38–2.51%), compared with the STABLE cohort (0.38%; IQR: 0.23–0.87%) (p=0.02); (2) dd-cfDNA level with AMR was elevated (1.34%; IQR: 0.34–2.40%) compared to STABLE, although it did not reach statistical significance (p=0.07) due to limitations in sample size; (3) there was no difference in dd-cfDNA for allograft INFXN (0.39%; IQR: 0.18–0.67%) versus STABLE, which may relate to differences in “tissue injury” with the spectrum of bronchial colonisation versus invasive infection; (4) there was no difference for d

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Nevertheless, there was an evident trend (1.34%; IQR: 0.34–2.40) for this cohort which should be further assessed in the context of a prospective multi-centre study.

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