Cell-Free DNA Levels During the First Hours After Liver Transplantation: A Key Biomarker for Patient Survival and Outcomes.

(1) Background: We propose that cfDNA levels may serve as a valuable biomarker for monitoring the progress of liver transplant recipients, reflecting the quality of the donated organ, and predicting patient prognosis and survival. Thus, we analyzed the relationship between total cfDNA levels during the first 48 h post-transplantation, ischemia-reperfusion injury, and patient outcomes. (2) Methods: cfDNA quantification was applied to 115 liver transplant patients using real-time quantitative PCR at the time of transplantation (during reperfusion) and throughout the first month post-transplantation. (3) Results: Significantly higher early cfDNA levels were observed in patients who suffered liver damage or post-transplantation complications during the first month. High cfDNA levels were also associated with prolonged ICU stays and reduced survival. Kaplan-Meier analysis revealed a significantly lower survival rate in patients with elevated cfDNA. CRP levels were elevated and significantly correlated with cfDNA values. Regarding organ preservation prior to transplantation, prolonged cold and warm ischemia times were significantly associated with high cfDNA levels in the early hours post-transplantation. (4) Conclusions: Elevated cfDNA levels in the early hours following liver transplantation are associated with poorer patient outcomes. Therefore, determining total cfDNA levels post-transplantation may be a valuable tool for patient management and early intervention.