ArticleNature communications2025
Continuous indices to assess the phenotypic spectrum of kidney transplant rejection.
Article in Nature communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Urinary CXCL9 Across the Spectrum of Kidney Allograft Inflammation.Kidney international reports · 2026Article
- Kidney Allograft Outcomes in Borderline and T Cell-Mediated Rejection With Microvascular Inflammation.Kidney international reports · 2026Article
- Clinical Relevance of Donor-Derived Cell-Free DNA in Monitoring Kidney Transplant Rejection.Journal of the American Society of Nephrology : JASN · 2026Observational
- Intragraft FOXP3+ Cells and Continuous Banff Indices in T Cell-Mediated Kidney Allograft Rejection.Medicina (Kaunas, Lithuania) · 2026Article
- Prolonged CD38 targeting with felzartamab in antibody-mediated kidney transplant rejection: a biomarker-guided open-label phase 2 extension.The Lancet regional health. Europe · 2026Article
- Qualified prediction system for allograft failure in real world settings: extended validation study.BMJ medicine · 2026Article
- Findings and significance of early follow-up biopsies after treatment of acute rejection in kidney transplant recipients.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Donor-Derived Cell-Free DNA as a Non-Invasive Readout of Activity Across the Rejection Continuum.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Article
- The Top 12 Most Impactful Papers in Clinical Transplantation in 2025: TI Editors' Choice.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- The new era of treatments for kidney transplant recipients.Jornal brasileiro de nefrologiaReview
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Authors and funding
31 authors.
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Abstract
The Banff classification for kidney transplant pathology dichotomizes the rejection continuum into distinct diagnostic categories, introducing artificial cutoff points and threshold effects. To better reflect the underlying disease spectrum, in this cohort study of 19,500 biopsies from 8873 patients across 10 centers worldwide, we developed two indices for quantifying antibody-mediated rejection/microvascular inflammation and T-cell-mediated rejection/tubulointerstitial inflammation from histological lesion scores and calculated indices for overall activity and chronicity. These indices demonstrate excellent discrimination for the main diagnostic categories of rejection (AUCs from 0.95 to 0.99), with consistent performance across derivation and validation datasets. These indices strictly confine intermediate phenotypes to low index values and are associated to graft failure even within the diagnostic categories, thus reflecting the underlying rejection continuum. In this work, we demonstrate that four continuous indices provide implementable and interpretable global evaluation of kidney transplant histology that align with the continuous nature of the rejection process regardless of the underlying disease cause.
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