To evaluate the association between PIRCHE scores and kidney allograft injury using biomarkers such as dd-cfDNA, DSA, histologic rejection, and molecular rejection signatures, specifically focusing on their predictive value.
Key Findings:
250 out of 683 recipients (37%) experienced the primary endpoint of allograft injury, indicating a significant incidence.
Higher PIRCHE-T2 and PIRCHE-B scores were significantly associated with increased risk of allograft injury, with adjusted hazard ratios per point increase of 1.009 for PIRCHE-T2 and 1.043 for PIRCHE-B.
Both PIRCHE scores demonstrated modest discriminatory performance with AUC values ranging from 0.575 to 0.621.
Higher PIRCHE scores correlated with an increased risk of de novo or recurrent DSA and elevation of dd-cfDNA.
Interpretation:
Higher PIRCHE scores suggest an increased risk of early alloimmune injury after kidney transplantation, offering a risk stratification method grounded in immunological mechanisms.
Limitations:
The study was conducted at a single center, which may limit the generalizability of the findings to broader populations.
The modest discriminatory performance of PIRCHE scores suggests that while they provide valuable insights, they should be used in conjunction with other assessment strategies.
Conclusion:
PIRCHE scores may enhance existing immunologic assessment strategies for predicting early allograft injury, although further validation is needed.
