Utility and limitations of the use of donor-derived cell-free DNA in kidney transplantation

Table 10 Interpretation of donor-derived cell-free DNA results according to the clinical context

Clinical context	dd-cfDNA result	Interpretation	Management
Acute graft dysfunction	High	Rejection likely	Biopsy to confirm
	Low	Rejection unlikely	Biopsy to exclude TCMR and other pathologies
Stable graft function	High	Rejection likely	Proceed with protocol biopsy
	Low	Rejection unlikely	Avoid protocol biopsy
Chronic graft dysfunction	High	Chronic AMR likely	Consider biopsy to guide treatment
	Low	Chronic AMR unlikely	Consider biopsy to detect other pathologies
Rejection undergoing treatment	High	Ongoing rejection	Continued treatment of rejection
	Low	Resolution of rejection	Clinical monitoring

dd-cfDNA: Donor-derived cell-free DNA; TCMR: T-cell mediated rejection; AMR: Antibody mediated rejection.