Association of PIRCHE scores and allograft injury in kidney transplant recipients
By
Miklos Z. Molnar
Kendon J. Holdaway
Divya Raghavan
Silviana Marineci
Suayp Oygen
Fruzsina Toth
Katalin Fornadi
June 8, 2026
Clinical Scorecard: Correlation Between PIRCHE Scores and Allograft Damage in Recipients of Kidney Transplants
At a Glance
Category Detail
Condition Kidney Transplantation Key Mechanisms PIRCHE scores quantify donor-derived HLA peptides presented to recipient CD4+ T cells, indicating alloimmune risk. Target Population Adult kidney transplant recipients transplanted between 2021 and 2024. Care Setting Single-center retrospective cohort study.
Key Highlights
Higher PIRCHE-T2 and PIRCHE-B scores are associated with increased risk of early alloimmune injury. 37% of recipients experienced post-transplant allograft injury within one year. PIRCHE-B scores improved prediction for donor-specific antibody (DSA) development. Modest discriminatory performance of PIRCHE scores (AUC 0.575–0.621). PIRCHE scores may complement existing immunologic assessment strategies. Guideline-Based Recommendations
Diagnosis
Evaluate PIRCHE scores for risk stratification in kidney transplant recipients. Management
Monitor for donor-specific antibody development and allograft injury using PIRCHE scores. Monitoring & Follow-up
Assess levels of donor-derived cell-free DNA (dd-cfDNA) and histologic or molecular rejection. Risks
Higher PIRCHE scores correlate with increased risk of de novo DSA and rejection. Patient & Prescribing Data
Adult kidney transplant recipients.
PIRCHE scores provide a mechanistic estimate of alloimmune risk.
Clinical Best Practices
Incorporate PIRCHE score assessment in the immunologic evaluation of kidney transplant recipients. Utilize high-resolution HLA typing for accurate PIRCHE score calculation. Related Resources & Content
