*Purpose: Donor-derived cell-free DNA such as AlloSure (CareDx) is used as a non-invasive biomarker for allograft rejection and allograft injury as increased dd-cfDNA is observed with increase in cell injury. Also, several studies demonstrated that the level of dd-cfDNA is affected by biological variations. In this study, we assessed the correlation between donor and recipient variations with amount of circulating dd-cfDNA in renal transplant patients to understand the additional factors that affect the % of circulating dd-cfDNA.

*Methods: One hundred and one kidney transplant patients with dd-cfDNA obtained at the first month post-transplant were included in this study.

*Results: At one-month post-transplant, the median dd-cfDNA were higher in kidney-pancreas dual transplant compare to the kidney transplant alone (1.5% vs 0.4%, n = 3 vs 98, p < 0.05) (Figure 1a). Also, the median dd-cfDNA for male donor gender was higher than female donor gender (0.575% vs 0.28%, n = 62 vs 38, p < 0.01) (Figure 1b). The median dd-cfDNA for the first month post-transplant dd-cfDNA for other demographic factors such as ethnicity, type of donors (DCD, LRD, LURD), KDPI, DGF status, HLA mismatch were not significantly different.

*Conclusions: Dual transplant, and male gender were associated with higher dd-cfDNA at the first month post-transplant kidney patients.

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