{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:11:31Z","timestamp":1790107891856,"version":"4.0.1"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic significance of subclinical rejection (SCR) and borderline rejection (BLR) detected on surveillance kidney allograft biopsies remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta\u2010analysis of studies enrolling adult kidney transplant (KT) recipients undergoing protocol biopsies. The primary outcome was death\u2010censored graft loss (DCGL); the secondary outcome was subsequent rejection. Random\u2010effects models, sensitivity analyses, and meta\u2010regression were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen studies (5428 recipients) were included. SCR was associated with a higher risk of DCGL (RR 2.22; 95% CI 1.67\u20132.95) and subsequent rejection (RR 3.09; 95% CI 2.34\u20134.09), with low heterogeneity. Both T cell\u2013mediated rejection (RR 1.82; 95% CI 1.28\u20132.61) and antibody\u2010mediated rejection (ABMR) (RR 3.35; 95% CI 2.11\u20135.33) were associated with increased DCGL. BLR was associated with increased DCGL (RR 2.40; 95% CI 1.67\u20133.46) and subsequent rejection (RR 2.79; 95% CI 2.10\u20133.69). Findings were robust across sensitivity analyses, including contemporary Banff\u2010era definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SCR and BLR are associated with inferior long\u2010term graft outcomes. These findings underscore their prognostic significance and warrant prospective studies to determine optimal management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70536","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:52:29Z","timestamp":1775645549000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Subclinical and Borderline Rejection are Associated With Death\u2010Censored Graft Loss After Kidney Transplantation: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5930-0022","authenticated-orcid":false,"given":"Takayuki","family":"Yamada","sequence":"first","affiliation":[{"name":"Division of Nephrology, Omihachiman Community Medical Center  Omihachiman Shiga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7609-0757","authenticated-orcid":false,"given":"Shota","family":"Obata","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology Stanford University School of Medicine  Palo Alto USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7398-9853","authenticated-orcid":false,"given":"Arjun","family":"Kalaria","sequence":"additional","affiliation":[{"name":"Florida Kidney Physicians  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0503-8788","authenticated-orcid":false,"given":"Abiha","family":"Abdullah","sequence":"additional","affiliation":[{"name":"University of Pittsburgh  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce","family":"Parrish","sequence":"additional","affiliation":[{"name":"Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massiel Cruz","family":"Peralta","sequence":"additional","affiliation":[{"name":"Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vrishketan","family":"Sethi","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3111-6749","authenticated-orcid":false,"given":"Charbel","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Transplantation University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Mial\u2010Anthony","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Transplantation University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4519-1472","authenticated-orcid":false,"given":"Michele","family":"Klein\u2010Fedyshin","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Health Sciences Library System (MKF)  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4856-9242","authenticated-orcid":false,"given":"Chethan","family":"Puttarajappa","sequence":"additional","affiliation":[{"name":"Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3770-8446","authenticated-orcid":false,"given":"Rajil","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8649-2901","authenticated-orcid":false,"given":"Aravind","family":"Cherukuri","sequence":"additional","affiliation":[{"name":"Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0321-4365","authenticated-orcid":false,"given":"Berkay","family":"Demirors","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Transplantation University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9763-6253","authenticated-orcid":false,"given":"Michele","family":"Molinari","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Transplantation University of Pittsburgh Medical Center  Pittsburgh USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"issue":"5","key":"e_1_2_11_2_1","first-page":"499","article-title":"Long\u2010Term Survival After Kidney Transplantation. Reply","volume":"386","author":"Hariharan S.","year":"2022","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16982"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00332.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2014530"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa013036"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03240.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14609"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199401001-00009"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V9112129"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa020009"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2006.01436.x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02966.x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000128167.60172.CC"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2022.07.030"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006030227"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15898"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD015983"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-085098"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.3163\/1536-5050.104.3.014"},{"key":"e_1_2_11_22_1","unstructured":"G. A.Wells B.Shea D.O'Connell et al. The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19981230)17:24<2815::AID-SIM110>3.0.CO;2-8"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003055"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.00830.x"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trim.2022.101594"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-015-0206-0"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002560"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2023.03.005"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2014040399"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trim.2006.12.001"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0159717"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001132"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002566"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16883"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001119"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15197"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15177"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2017030287"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016091034"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.11.034"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15822"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13753"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16150"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70536","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70536","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T17:09:44Z","timestamp":1777223384000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":43,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/ctr.70536"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70536","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2026-01-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70536"}}