GENOMICS
may be travelling from quite a wide geographical area.” Talking about the potential of using
dd-cfDNA, she added: “There are a multitude of research papers looking at dd-cfDNA levels in the literature. It’s got a really good negative predictive value for ruling out rejection, but it lacks specificity because you can have elevated levels of cfDNA for other reasons. For example, it could be that your recipient component can increase due to things like exercise. So you have to be careful when you’re interpreting these quantitative values.” Peacock’s research team looked at
Sarah Peacock is developing a pilot study investigating the use of dd-cfDNA for post-transplant heart monitoring, expanding on her research on standardising pre-analytical conditions for dd-cfDNA quantification in solid organ transplantation.
within a busy diagnostic laboratory. She commented: “We already had a Maxwell instrument that we used to extract DNA for HLA typing, so it made sense to build on a platform our staff were already familiar with. The Rapid ccfDNA kit is automated, requires minimal hands-on time and fited easily into our existing workflow. Without looking at the clinical utility yet, from an operational perspective I would say the process is both feasible and practical to implement in the laboratory.” Preliminary analytical evaluation
demonstrated good agreement with expected assay performance and showed the workflow could consistently generate cfDNA of suitable quality for downstream analysis. Clinical evaluation of approximately 200 transplant samples is continuing to determine the role of dd-cfDNA in supporting earlier detection of kidney allograft injury.
Post-transplant heart monitoring The use of dd-cfDNA is also generating interest among other UK clinical researchers with some now moving from evaluation towards implementation and
standardisation. Also speaking at the event, Sarah Peacock, Consultant Clinical Scientist and Director of the Tissue Typing Laboratory at Addenbrooke’s Hospital, Cambridge, stated that Addenbrooke’s (together with Royal Papworth Hospital) is developing a pilot study investigating the use of dd-cfDNA for post-transplant heart monitoring. She shared her research on ‘Standardising Pre-Analytical Conditions for Reliable Donor-Derived Cell-Free DNA Quantification in Solid Organ Transplantation’. In her presentation, Peacock
highlighted the practical considerations of implementing dd-cfDNA testing in clinical laboratories, including the importance of high-quality cfDNA extraction and next- generation sequencing (NGS) workflows to ensure accurate results. Discussing the need for an alternative
clinical approach to biopsy, Peacock commented: “A heart biopsy is very invasive. It normally happens in a catheter laboratory, so you’re taking up laboratory time in the hospital. At Papworth, their routine is after the first month to do a biopsy once a month for 12 months, so it’s quite arduous for the patients, who
two different blood tube types and two different DNA extraction platforms. They found that Streck and PAXgene blood collection tubes demonstrated comparable analytical performance. PAXgene tubes (Qiagen) offered a meaningful practical advantage through their plastic construction. To determine whether the choice
of extraction platform influenced sample quality, the team compared two automated extraction systems using PAXgene blood collection tubes and a 4 mL plasma input. Both platforms consistently produced cell-free DNA of sufficient quality and quantity to meet the acceptance criteria for downstream NGS, demonstrating that either approach could be successfully implemented within a clinical workflow. Although the comparison revealed
some differences in extraction characteristics, these reflected the underlying chemistry of the two systems rather than differences in overall performance. The comparator platform generated a higher total DNA yield, but this included a greater proportion of high molecular weight genomic DNA. In contrast, the Maxwell system recovered a slightly lower total DNA concentration while producing a cleaner, more cfDNA- enriched extract (Fig 1). As dd-cfDNA testing relies on analysing these short DNA fragments, the proportion of cfDNA is considered a more meaningful measure of sample quality than total DNA yield alone. Both systems were also capable of producing results within a timeframe compatible with same-day downstream analysis. Peacock commented: “Ultimately, the
Collaborations between clinicians, clinical scientists and researchers are helping to build the evidence and practical experience needed for wider adoption
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WWW.PATHOLOGYINPRACTICE.COM September 2026
decision wasn’t based on a single factor. Both platforms produced DNA of sufficient quality for downstream analysis, but Maxwell integrated well into our existing workflow, was quick and straightforward for the team to use, and fited within the space constraints of our laboratory. The support we received from Promega during the evaluation also made the implementation process much smoother.”
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