Donor-derived cell-free DNA is associated with acute rejection and decreased oxygenation in primary graft dysfunction after living donor-lobar lung transplantation

Sci Rep. 2018 Oct 18;8(1):15366. doi: 10.1038/s41598-018-33848-3.


Donor-derived cell-free DNA (dd-cf-DNA) has been shown to be an informative biomarker of rejection after lung transplantation (LT) from deceased donors. However, in living-donor lobar LT, because small grafts from blood relatives are implanted with short ischemic times, the detection of dd-cf-DNA might be challenging. Our study was aimed at examining the role of dd-cf-DNA measurement in the diagnosis of primary graft dysfunction and acute rejection early after living-donor lobar LT. Immediately after LT, marked increase of the plasma dd-cf-DNA levels was noted, with the levels subsequently reaching a plateau with the resolution of primary graft dysfunction. Increased plasma levels of dd-cf-DNA were significantly correlated with decreased oxygenation immediately (p = 0.022) and at 72 hours (p = 0.046) after LT. Significantly higher plasma dd-cf-DNA levels were observed in patients with acute rejection (median, 12.0%) than in those with infection (median, 4.2%) (p = 0.028) or in a stable condition (median, 1.1%) (p = 0.001). Thus, measurement of the plasma levels of dd-cf-DNA might be useful to monitor the severity of primary graft dysfunction, and plasma dd-cf-DNA could be a potential biomarker for the diagnosis of acute rejection after LT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Cell-Free Nucleic Acids / analysis
  • Cell-Free Nucleic Acids / blood*
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Graft Rejection / blood
  • Graft Rejection / diagnosis*
  • Graft Rejection / etiology
  • Graft Rejection / mortality
  • Humans
  • Living Donors*
  • Lung Transplantation* / adverse effects
  • Lung Transplantation* / methods
  • Lung Transplantation* / mortality
  • Male
  • Middle Aged
  • Oxygen Consumption / physiology*
  • Predictive Value of Tests
  • Primary Graft Dysfunction / blood
  • Primary Graft Dysfunction / diagnosis*
  • Primary Graft Dysfunction / etiology
  • Primary Graft Dysfunction / mortality
  • Prognosis
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / mortality
  • Risk Factors
  • Young Adult


  • Cell-Free Nucleic Acids