Identification of a score allowing the diagnosis of subclinical rejection in renal transplantation

Based on a combination of 6 blood genes associated with tolerance in renal transplantation, we showed that this score was decreased in patients developing anti-HLA or donor-specific antibodies. After validating this association on a multicenter cohort of 588 patients with matched biopsies one year post-transplant, we showed conversely a significant decrease of this score in patients with subclinical rejection. Considering this early rejection as associated with a poor prognosis of graft survival, we refined this score with only two genes, AKR1C3 and TCL1A, and 4 clinical parameters, and showed that it was able to identify patients at low risk of developing subclinical rejection. This score, validated by two techniques (PCR, NanoString) and on a second independent cohort of 447 patients, should make it possible to improve the follow-up of kidney transplanted patients. @2023 Academie nationale de medcine. Published by Elsevier Masson SAS. All rights reserved.