Journal article
Donor-Derived Cell-Free DNA in Stable Pediatric Kidney Transplant Recipients: Influence of Donor Obesity and Recipient Size
Pediatric transplantation, Vol.30(8), e70416
08/2026
DOI: 10.1111/petr.70416
PMCID: PMC13479775
PMID: 42606109
Abstract
Donor-derived cell-free DNA (dd-cfDNA) is increasingly used as a noninvasive marker of kidney allograft injury, but adult-derived cutoffs may not be applicable to pediatric recipients, particularly in the setting of donor-recipient size mismatch. We evaluated dd-cfDNA levels in stable pediatric kidney transplant (KT) recipients and assessed variation by recipient weight and donor body mass index (BMI).
Retrospective data were collected from seven U.S. pediatric KT centers. Clinically stable recipients < 18 years of age (no de novo donor specific antibody, biopsy-proven rejection or BK viremia/nephropathy), with ≥ 2 dd-cfDNA measurements per year were included. Recipients were stratified by weight at dd-cfDNA collection (< 20 kg, 20-50 kg, > 50 kg). Donor BMI was categorized as underweight (≤ 18.5), normal (18.6-24.9), overweight (25-29.9), or obese (≥ 30). Comparisons were performed using linear mixed-effects models.
Among 178 recipients, mean dd-cfDNA did not differ by recipient weight (< 20 kg: 0.51 ± 0.44; 20-50 kg: 0.65 ± 1.28; > 50 kg: 0.49 ± 0.70). Median dd-cfDNA was similar across donor BMI categories. However, among obese donors, recipients < 20 kg had 1.3-fold higher dd-cfDNA (p = 0.044). Donor-recipient body surface area mismatch > 1.5 was associated with 1.083-fold higher dd-cfDNA up to 5 years post-transplant (p = 0.016).
In stable pediatric KT recipients, dd-cfDNA levels were well below the adult-derived 1% cutoff, reinforcing the generalizability of this cutoff to the pediatric population. Recipients < 20 kg with donor BMI > 30 kg/m
or in the setting of a donor-recipient BSA mismatch > 1.5 were associated with higher dd-cfDNA levels.
Details
- Title: Subtitle
- Donor-Derived Cell-Free DNA in Stable Pediatric Kidney Transplant Recipients: Influence of Donor Obesity and Recipient Size
- Creators
- Julia Steinke - Helen DeVos Children's HospitalLyndsay Harshman - University of Iowa Stead Family Children’s HospitalKelly Kirshner - Cedars-Sinai Medical CenterArundhati Kale - University of California, DavisErica Winnicki - University of California, San FranciscoDaniel Ranch - The University of Texas at San Antonio Health Science CenterJayanthi Chandar - University of MiamiHelen Pizzo - Cedars-Sinai Medical CenterArshdeep Kaur - University of Iowa Stead Family Children’s HospitalPaul Hanson - Veterans Health AdministrationZunqiu Chen - CareDx, Inc. (United States)Ling Shen - CareDx, Inc. (United States)Dechu Puliyanda - Cedars-Sinai Medical Center
- Resource Type
- Journal article
- Publication Details
- Pediatric transplantation, Vol.30(8), e70416
- DOI
- 10.1111/petr.70416
- PMID
- 42606109
- PMCID
- PMC13479775
- NLM abbreviation
- Pediatr Transplant
- ISSN
- 1397-3142
- eISSN
- 1399-3046
- Publisher
- Wiley
- Language
- English
- Date published
- 08/2026
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Iowa Neuroscience Institute
- Record Identifier
- 9985219307402771
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