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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Biopsy-based transcript diagnostics provide an objective approach to evaluating kidney allograft biopsies, complementing traditional histopathology. However, their diagnostic performance and clinical impact may vary across transplant centers due to center-specific factors. Recognizing this, the Banff 2022 Work Plan emphasizes the need to validate biopsy-based transcript assays in diverse clinical settings to ensure consistent interpretation across centers.
A total of 755 kidney allograft biopsies from two European transplant centers (Prague and Zurich) were analyzed using the Molecular Microscope® Diagnostic System (MMDx®) in two reference laboratories located in Portland, USA, and Prague, Czechia. Histopathological lesion scores were compared with MMDx molecular classifier categories and probability scores using a cumulative link proportional model. The study cohort included 145 cases of antibody-mediated rejection (AMR), 117 probable AMR, 64 cases of DSA-negative and C4d-negative microvascular inflammation (MVI), and 93 cases of T cell–mediated rejection (TCMR).
Histological lesions, including glomerulitis (g), peritubular capillaritis (ptc), interstitial inflammation (i), and tubulitis (t), were strongly associated with their corresponding molecular lesion and classifier scores across centers (p < 0.005). However, when adjusting for molecular lesion and classifier scores in a multivariate cumulative link proportional odds model, histological grading remained significantly influenced by the transplant center (p < 0.001). When holding the molecular AMR classifier score constant, the odds ratio (OR) for higher microvascular inflammation (MVI) in Zurich was 1.838 (95% CI 1.330–2.549; p < 0.001). Notably, MVI severity was not affected by donor-specific antibody (DSA) status (OR 0.983; 95% CI 0.729–1.326; p = 0.915). Similarly, when controlling for either the molecular AMR or TCMR classifier score, the odds of higher intimal arteritis (v-lesion) grading in Zurich were markedly increased (OR 5.027; 95% CI 3.129–8.355; p < 0.001 and OR 4.832; 95% CI 2.994–8.077; p < 0.001, respectively). Finally, glomerular basement membrane double contours (cg) were associated with a higher molecular cg > 0 probability only in the presence of MVI across centers (p < 0.05).
Histological lesions remain major drivers of molecular diagnostic readouts across centers. Yet, significant inter-center variability suggests that biopsy indication, timing, and local pathology practices impact the relationship between molecular and histological findings. Therefore, the added diagnostic value of MMDx should not be assumed universal but should be critically assessed within the center’s clinical and histopathological environment.
