Donor-derived cell-free DNA (dd-cfDNA) is a potential noninvasive molecular marker of graft rejection after kidney transplant, whose diagnostic accuracy remains controversial.
We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy of dd-cfDNA. Relevant literature was searched from online databases, and the data on the diagnostic accuracy of discriminating main rejection episodes (MRE) and antibody-mediated rejection (AMR) were merged, respectively.
Nine studies were included in the meta-analysis, of which 6 were focused on the diagnostic accuracy of dd-cfDNA for MRE, whose pooled sensitivity, specificity, area under the receiver operating characteristics curve (AUC), diagnostic odds ratio(DOR), overall positive likelihood ratio (PLR), and negative likelihood ratio (NLR) with 95% confidence intervals were 0.70(0.57-0.81), 0.78(0.70-0.84), 0.81(0.77-0.84), 8.18(5.11-13.09), 3.15(2.47-4.02), 0.39(0.27-0.55), respectively. 5 tests were focused on discriminating AMR, whose pooled indicators were 0.84(0.75-0.90), 0.80(0.74-0.84), 0.89(0.86-0.91), 20.48(10.76-38.99), 4.13(3.21-5.33), 0.20(0.12-0.33), respectively.
Donor-derived cell-free DNA can be a helpful marker for the diagnosis of antibody-mediated rejection among those recipients suspected of renal dysfunction. Its diagnostic accuracy on the main rejection episodes remains uncertain, which requires further prospective, large-scale, multicenter, and common population research.

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