20.500.12556/RUL-181417 Improving the histologic detection of DSA-negative antibody-mediated rejection in kidney transplants Emerging treatments for antibody-mediated rejection (ABMR, NEJM391(2):122-132) have increased the importance of ABMR detection when donor-specific antibody (DSA) is negative. We addressed this issue in the Trifecta-Kidney study (ClinicalTrials.gov #NCT04239703) using three centralized tests in 690 kidney transplant biopsies: DSA (One Lambda Inc.), blood donor-derived cell-free DNA (dd-cfDNA, Prospera™ test, Natera, Inc.), and molecular biopsy assessment (MMDx). We used an “AutoBanff 2022” algorithm to model the impact of alternative DSA interpretations on the histologic diagnosis of “DSA-negative” ABMR following Banff guidelines, including agreement with dd-cfDNA and molecular ABMR. Lowering MFI cutoffs for DSA-positivity did not improve detection of DSA-negative ABMR. However, simply calling all DSA positive allowed Banff 2022 guidelines to identify 46% more ABMR cases with no measurable DSA, and per Net Reclassification Improvement increased agreement between histologic diagnoses and both dd-cfDNA (P=7.72E-7) and molecular ABMR (P=7.69E-7). New ABMR cases were as strongly positive for dd-cfDNA and molecular ABMR as those found using the conventional DSA interpretation. A validation set analysis using INTERCOMEX study data (ClinicalTrials.gov NCT#01299168) confirmed these findings, and found that the new DSA-negative ABMR cases identified by calling all DSA positive had the same risk for graft loss as those found with conventional DSA interpretation. donor-derived cell-free DNA kidney biopsy donor-specific antibody microarrays antibody-mediated rejection kidney transplant rejection true false true Angleški jezik Ni določen Članek v reviji 2026-04-07 09:09:14 2026-04-07 09:09:21 2026-07-15 12:11:59 0000-00-00 00:00:00 2026 0 0 Str. 117-130 iss. 1 Vol. 26 2026 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.61 1600-6143 10.1016/j.ajt.2025.08.029 246735107 RAZ_Hidalgo_Luis_G._2026.pdf RAZ_Hidalgo_Luis_G._2026.pdf 1 945050CA962CDA9C441E173C598C5771 6e46ef057b5d851c08a240dbf7599de1597121f7390a429470c8ae649318041b 2c5a43d1-325b-11f1-b0ab-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=231844 https://www.sciencedirect.com/science/article/pii/S1600613525029430 0 aede58cf-661e-11f1-9b0d-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=235407 Medicinska fakulteta 0 0 0