Evidence map›Paper›PMID 41949047›Full record

SynthesisClinical transplantation2026

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 and 5 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Takayuki YamadaDivision of Nephrology, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan.ORCID https://orcid.org/0000-0001-5930-0022
Shota ObataDepartment of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, USA.ORCID https://orcid.org/0000-0002-7609-0757
Arjun KalariaFlorida Kidney Physicians, Jacksonville, Florida, USA.ORCID https://orcid.org/0009-0009-7398-9853
Abiha AbdullahUniversity of Pittsburgh, Pittsburgh, USA.ORCID https://orcid.org/0009-0003-0503-8788
Bryce ParrishDivision of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.
Massiel Cruz PeraltaDivision of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.
Vrishketan SethiDepartment of Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Charbel EliasDepartment of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, USA.ORCID https://orcid.org/0000-0002-3111-6749
Jason Mial-AnthonyDepartment of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, USA.
Michele Klein-FedyshinUniversity of Pittsburgh, Health Sciences Library System (MKF), Pittsburgh, USA.ORCID https://orcid.org/0000-0003-4519-1472
Chethan PuttarajappaDivision of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.ORCID https://orcid.org/0000-0002-4856-9242
Rajil MehtaDivision of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.ORCID https://orcid.org/0000-0002-3770-8446
Aravind CherukuriDivision of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.ORCID https://orcid.org/0000-0002-8649-2901
Berkay DemirorsDepartment of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, USA.ORCID https://orcid.org/0000-0003-0321-4365
Michele MolinariDepartment of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, USA.ORCID https://orcid.org/0000-0002-9763-6253

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe prognostic significance of subclinical rejection (SCR) and borderline rejection (BLR) detected on surveillance kidney allograft biopsies remains uncertain.

methodsWe 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.

resultsFifteen 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.

conclusionsSCR 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.

Indexed as

Graft RejectionGraft SurvivalKidney Failure, ChronicKidney TransplantationPostoperative ComplicationsHumansPrognosisRisk Factorsacute rejectiondeath‐censored graft losskidney transplantrejectionsubclinical inflammationsubclinical rejection

Identifiers

PMID41949047
PMCPMC13059068

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.