{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:30:31Z","timestamp":1786480231473,"version":"build-2736575974"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"abstract":"\n Background<\/jats:title>\n The primary objective of this analysis was to assess the association between non-invasive biomarker results within the first 2-years post-kidney transplant and 10-year All Cause Graft Loss (ACGL).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n CTOT-08 was linked with the Scientific Registry of Transplant Recipients (SRTR) to assess 10-year ACGL. Cox Regression was used to determine the association between gene expression profile (GEP) and donor-derived cell-free DNA (dd-cfDNA) results and ACGL. A Cox Regression with time-varying covariates was used to test associations with ACGL with simultaneous and repeated biomarker results.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The final landmarked Cox model included clinical acute rejection (aHR 2.58 (1,30,5.13) for 1 rejection, aHR 3.41 (1.07,10.85) for 2 rejections), diabetes (aHR 1.71 (0.99,2.96)), recipient age (aHR 1.02 (1.00,1.04)), the highest quartile of positive GEP (aHR 2.44 (1.45,4.10)) and the highest quartile of positive dd-cfDNA (aHR 2.91 (1.77,4.78)). In the time-varying model, having both biomarkers positive at the same time carried the greatest association with ACGL (aHR 4.29 (2.10,8.76)).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this multicenter, prospective analysis of GEP and dd-cfDNA on patient and graft outcomes, an independent association with long-term ACGL was demonstrated. Further, a time-varying analysis demonstrated that two biomarkers with independent methodologies tested at the same time can provide more information than either one alone.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000001167","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T17:06:27Z","timestamp":1772557587000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Association of Noninvasive Rejection Biomarkers with 10-year Kidney Allograft Survival"],"prefix":"10.34067","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9686-3107","authenticated-orcid":false,"given":"James N.","family":"Fleming","sequence":"first","affiliation":[{"name":"College of Medicine, Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Taber","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond L.","family":"Heilman","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mayo Clinic, Phoenix, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1492-5103","authenticated-orcid":false,"given":"Emilio","family":"Poggio","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6517-076X","authenticated-orcid":false,"given":"Christopher","family":"Marsh","sequence":"additional","affiliation":[{"name":"Division of Organ Transplantation, Scripps Clinic, La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7782-7263","authenticated-orcid":false,"given":"Sunil","family":"Kurian","sequence":"additional","affiliation":[{"name":"Division of Organ Transplantation, Scripps Clinic, La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6877-9490","authenticated-orcid":false,"given":"Lihui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Northwestern University, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4826-481X","authenticated-orcid":false,"given":"Mulugeta","family":"Gebregziabher","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5942-2118","authenticated-orcid":false,"given":"Steve","family":"Kleiboeker","sequence":"additional","affiliation":[{"name":"Research and Development, Eurofins Viracor, Lenexa, KS"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9344-9928","authenticated-orcid":false,"given":"John J.","family":"Friedewald","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,3]]},"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001167","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:59:02Z","timestamp":1786478342000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":0,"URL":"https:\/\/doi.org\/10.34067\/kid.0000001167","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"assertion":[{"value":"2025-08-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}