Subclinical and Borderline Rejection are Associated With Death‐Censored Graft Loss After Kidney Transplantation: A Systematic Review and Meta‐Analysis
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Wiley
2026
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| author | Takayuki Yamada Shota Obata Arjun Kalaria Abiha Abdullah Bryce Parrish Massiel Cruz Peralta Vrishketan Sethi Charbel Elias Jason Mial‐Anthony Michele Klein‐Fedyshin Chethan Puttarajappa Rajil Mehta Aravind Cherukuri Berkay Demirors Michele Molinari |
| author_facet | Takayuki Yamada Shota Obata Arjun Kalaria Abiha Abdullah Bryce Parrish Massiel Cruz Peralta Vrishketan Sethi Charbel Elias Jason Mial‐Anthony Michele Klein‐Fedyshin Chethan Puttarajappa Rajil Mehta Aravind Cherukuri Berkay Demirors Michele Molinari Takayuki Yamada Shota Obata Arjun Kalaria Abiha Abdullah Bryce Parrish Massiel Cruz Peralta Vrishketan Sethi Charbel Elias Jason Mial‐Anthony Michele Klein‐Fedyshin Chethan Puttarajappa Rajil Mehta Aravind Cherukuri Berkay Demirors Michele Molinari |
| collection | Wiley Open Access |
| contents | Subclinical and Borderline Rejection are Associated With Death‐Censored Graft Loss After Kidney Transplantation: A Systematic Review and Meta‐Analysis Takayuki Yamada Shota Obata Arjun Kalaria Abiha Abdullah Bryce Parrish Massiel Cruz Peralta Vrishketan Sethi Charbel Elias Jason Mial‐Anthony Michele Klein‐Fedyshin Chethan Puttarajappa Rajil Mehta Aravind Cherukuri Berkay Demirors Michele Molinari Clinical Transplantation ABSTRACT Background The prognostic significance of subclinical rejection (SCR) and borderline rejection (BLR) detected on surveillance kidney allograft biopsies remains uncertain. Methods We performed a systematic review and meta‐analysis of studies enrolling adult kidney transplant (KT) recipients undergoing protocol biopsies. The primary outcome was death‐censored graft loss (DCGL); the secondary outcome was subsequent rejection. Random‐effects models, sensitivity analyses, and meta‐regression were used. Results Fifteen studies (5428 recipients) were included. SCR was associated with a higher risk of DCGL (RR 2.22; 95% CI 1.67–2.95) and subsequent rejection (RR 3.09; 95% CI 2.34–4.09), with low heterogeneity. Both T cell–mediated rejection (RR 1.82; 95% CI 1.28–2.61) and antibody‐mediated rejection (ABMR) (RR 3.35; 95% CI 2.11–5.33) were associated with increased DCGL. BLR was associated with increased DCGL (RR 2.40; 95% CI 1.67–3.46) and subsequent rejection (RR 2.79; 95% CI 2.10–3.69). Findings were robust across sensitivity analyses, including contemporary Banff‐era definitions. Conclusions SCR and BLR are associated with inferior long‐term graft outcomes. These findings underscore their prognostic significance and warrant prospective studies to determine optimal management strategies. 10.1111/ctr.70536 http://creativecommons.org/licenses/by/4.0/ |
| doi_str_mv | 10.1111/ctr.70536 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70536 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by/4.0/ |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Subclinical and Borderline Rejection are Associated With Death‐Censored Graft Loss After Kidney Transplantation: A Systematic Review and Meta‐Analysis Takayuki Yamada Shota Obata Arjun Kalaria Abiha Abdullah Bryce Parrish Massiel Cruz Peralta Vrishketan Sethi Charbel Elias Jason Mial‐Anthony Michele Klein‐Fedyshin Chethan Puttarajappa Rajil Mehta Aravind Cherukuri Berkay Demirors Michele Molinari Clinical Transplantation Subclinical and Borderline Rejection are Associated With Death‐Censored Graft Loss After Kidney Transplantation: A Systematic Review and Meta‐Analysis Takayuki Yamada Shota Obata Arjun Kalaria Abiha Abdullah Bryce Parrish Massiel Cruz Peralta Vrishketan Sethi Charbel Elias Jason Mial‐Anthony Michele Klein‐Fedyshin Chethan Puttarajappa Rajil Mehta Aravind Cherukuri Berkay Demirors Michele Molinari Clinical Transplantation ABSTRACT Background The prognostic significance of subclinical rejection (SCR) and borderline rejection (BLR) detected on surveillance kidney allograft biopsies remains uncertain. Methods We performed a systematic review and meta‐analysis of studies enrolling adult kidney transplant (KT) recipients undergoing protocol biopsies. The primary outcome was death‐censored graft loss (DCGL); the secondary outcome was subsequent rejection. Random‐effects models, sensitivity analyses, and meta‐regression were used. Results Fifteen studies (5428 recipients) were included. SCR was associated with a higher risk of DCGL (RR 2.22; 95% CI 1.67–2.95) and subsequent rejection (RR 3.09; 95% CI 2.34–4.09), with low heterogeneity. Both T cell–mediated rejection (RR 1.82; 95% CI 1.28–2.61) and antibody‐mediated rejection (ABMR) (RR 3.35; 95% CI 2.11–5.33) were associated with increased DCGL. BLR was associated with increased DCGL (RR 2.40; 95% CI 1.67–3.46) and subsequent rejection (RR 2.79; 95% CI 2.10–3.69). Findings were robust across sensitivity analyses, including contemporary Banff‐era definitions. Conclusions SCR and BLR are associated with inferior long‐term graft outcomes. These findings underscore their prognostic significance and warrant prospective studies to determine optimal management strategies. 10.1111/ctr.70536 http://creativecommons.org/licenses/by/4.0/ |
| title | Subclinical and Borderline Rejection are Associated With Death‐Censored Graft Loss After Kidney Transplantation: A Systematic Review and Meta‐Analysis |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70536 |