Unexplained Elevated Cell-Free DNA in a Kidney Transplant Patient With Stable Clinical Parameters: A Case Report and Literature Review

Cell-free DNA (cfDNA) is an emerging noninvasive biomarker for detecting graft injury and rejection in kidney transplantation. Although elevated cfDNA levels often indicate underlying pathology, their interpretation can be challenging in patients with stable graft function and no clinical signs of rejection. We present a case of a kidney transplant recipient with persistently elevated cfDNA levels despite stable renal function, negative donor-specific antibodies (DSA), and unremarkable clinical findings. A biopsy revealed chronic arteriolar hyalinosis but no evidence of rejection. This case underscores the complexities of cfDNA interpretation in transplant monitoring and highlights the need for further research to refine its clinical application.