Clinical Rationale for a Routine Testing Schedule Using Donor-Derived Cell-Free DNA After Kidney Transplantation

Akshta Pai, Joshua T. Swan, David Wojciechowski, Yasir Qazi, Sham Dholakia, Grigoriy Shekhtman, Anas Abou-Ismail, Dhiren Kumar

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Kidney transplant recipients require meticulous clinical and laboratory surveillance to monitor allograft health. Conventional biomarkers, including serum creatinine and proteinuria, are lagging indicators of allograft injury, often rising only after significant and potentially irreversible damage has occurred. Immunosuppressive medication levels can be followed, but their utility is largely limited to guiding dosing changes or assessing adherence. Kidney biopsy, the criterion standard for the diagnosis and characterization of injury, is invasive and thus poorly suited for frequent surveillance. Donor-derived cell-free DNA (dd-cfDNA) is a sensitive, noninvasive, leading indicator of allograft injury, which offers the opportunity for expedited intervention and can improve long-term allograft outcomes. This article describes the clinical rationale for a routine testing schedule utilizing dd-cfDNA surveillance at months 1, 2, 3, 4, 6, 9, and 12 during the first year following kidney transplantation and quarterly thereafter. These time points coincide with major immunologic transition points after transplantation and provide clinicians with molecular information to help inform decision making.

Original languageEnglish (US)
Article numbere932249
Pages (from-to)e932249
JournalAnnals of Transplantation
StatePublished - Jul 2 2021


  • Biomarkers
  • Cell-free nucleic acids
  • Graft rejection
  • Immunologic surveillance
  • Kidney transplantation
  • Pathology, molecular

ASJC Scopus subject areas

  • Transplantation


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