When should matching scores change interpretation of dd-cfDNA?
Could donor–recipient genetic matching scores improve interpretation of serial donor-derived cell-free DNA, rather than merely stratify baseline risk? A convincing analysis would preserve the sequence of sampling: pre-injury baseline, marker rise, biopsy or other injury assessment, treatment, and subsequent trajectory. The key comparison is time-matched discrimination among rejection, non-rejection injury, and stable graft function, with treatment changes modeled explicitly. Does adding a matching score improve those distinctions beyond prior dd-cfDNA values and time since transplant, and is any gain confined to particular post-transplant intervals? The transplant-outcomes genetics study provides a relevant starting point, but longitudinal molecular validation remains the decisive test.