Repeated histological diagnoses and kidney graft failure: an observational cohort study

A second rejection-related injury Banff diagnosis after kidney transplantation predicts markedly higher death-censored graft failure risk (HR 9.31, 95% CI 5.84–14.85) in a 2004–2021 cohort.

• Why it matters: Banff diagnoses are snapshots, yet repeated injury can occur without clinical signs; the clinical consequences of recurrence and subclinical episodes are unclear.
• What they did: In a single-center observational cohort of 1818 kidney transplantations with 5218 biopsies (82% protocol), investigators modeled transitions among six Banff diagnoses and used a multistate approach to estimate cause-specific hazards of graft failure.
• The result: After a first RRI diagnosis, graft failure risk increased (HR 2.18, 95% CI 1.35–3.51), and risk rose substantially after a second (HR 9.31, 95% CI 5.84–14.85); among protocol biopsies without clinical signs, associations persisted (HR 1.76 and HR 2.58).

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