{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"bioRxiv"}],"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T21:00:32Z","timestamp":1785358832162,"version":"3.55.0"},"posted":{"date-parts":[[2026,7,27]]},"group-title":"Pathology","reference-count":35,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.biorxiv.org\/about\/FAQ#license"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["R37AI051652"],"award-info":[{"award-number":["R37AI051652"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["DK087824"],"award-info":[{"award-number":["DK087824"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Clinical and Translational Science Center Award, NIH","award":["UL1TR000457"],"award-info":[{"award-number":["UL1TR000457"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,27]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>\n                  Banff acute lesion scores underpin histologic classification of kidney allograft biopsies; however, biomarker studies rely on second-order associations with diagnostic categories that introduce confounding. We quantified the first-order relationships between Banff acute lesion scores and the validated urinary cell three-gene rejection signature. In 354 biopsy-urine pairs, three-gene signature scores computed using a locked regression equation incorporating absolute copy numbers of CD3E mRNA, CXCL10 mRNA, and 18S rRNA in urinary cell RNA-were related to glomerulitis (\n                  <jats:italic>g<\/jats:italic>\n                  ), peritubular capillaritis (\n                  <jats:italic>ptc<\/jats:italic>\n                  ), interstitial inflammation (\n                  <jats:italic>i<\/jats:italic>\n                  ), and tubulitis (\n                  <jats:italic>t<\/jats:italic>\n                  ). Signature scores rose monotonically with Banff acute lesion severity, with 1.5 to 1.8-fold higher odds of more severed\n                  <jats:italic>g, ptc, i,<\/jats:italic>\n                  and\n                  <jats:italic>t<\/jats:italic>\n                  (all P&lt;0.0001), and showed good calibration. Associations remained robust for composite microvascular (\n                  <jats:italic>g+ptc<\/jats:italic>\n                  ) and tubulointerstitial (\n                  <jats:italic>i+t<\/jats:italic>\n                  ) indices and were strongest for severe\n                  <jats:italic>g<\/jats:italic>\n                  and\n                  <jats:italic>t<\/jats:italic>\n                  , supporting this signature as a noninvasive, quantitative readout of acute rejection pathology with immediate diagnostic applicability.\n                <\/jats:p>","DOI":"10.64898\/2026.07.22.740171","type":"posted-content","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:20:26Z","timestamp":1785172826000},"source":"Crossref","is-referenced-by-count":0,"title":["First Order Associations Between Banff Acute Lesions in Kidney Allograft Biopsies and a Urinary Cell Three-Gene Diagnostic Signature"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3241-5223","authenticated-orcid":false,"given":"Carol","family":"Li","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thalia","family":"Salinas","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America"},{"name":"Department of Transplantation Medicine, NewYork Presbyterian Hospital-Weill Cornell Medical College, New York, New York, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7973-1521","authenticated-orcid":false,"given":"Darshana M.","family":"Dadhania","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America"},{"name":"Department of Transplantation Medicine, NewYork Presbyterian Hospital-Weill Cornell Medical College, New York, New York, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"DeVito","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Higgins","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Salvatore","sequence":"additional","affiliation":[{"name":"Division of Renal Pathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4384-0694","authenticated-orcid":false,"given":"Surya V.","family":"Seshan","sequence":"additional","affiliation":[{"name":"Division of Renal Pathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay K.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0294-6209","authenticated-orcid":false,"given":"Thangamani","family":"Muthukumar","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America"},{"name":"Department of Transplantation Medicine, NewYork Presbyterian Hospital-Weill Cornell Medical College, New York, New York, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6894-0486","authenticated-orcid":false,"given":"Manikkam","family":"Suthanthiran","sequence":"additional","affiliation":[{"name":"Division of Nephrology and 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