*2.3. Circulating LNC-EPHA6 Levels Directly Correlate with Acute Rejection*

In order to assess the relationship between AR and vascular injury related lncRNAs LNC-RPS24, MALAT1, LNC-EPHA6, and LIPCAR, circulating levels of these lncRNAs were measured in stable patients and AR patients. In this cohort, MALAT1 levels were only detectable in less than 30% of patients and therefore not included in further analyses. Relative expression of circulating LNC-EPHA6 was significantly higher in patients with AR, compared with stable patients (*p* = 0.017; Figure 2). LNC-RPS24 and LIPCAR showed a similar trend, although these differences did not reach statistical significance (resp. *p* = 0.11 and *p* = 0.16).

**Figure 2.** Circulating lncRNA levels are effected by acute rejection. Relative expression of LNC-RPS24 (**A**), LNC-EPHA6 (**B**), and LIPCAR (**C**) in the cross-sectional cohort; kidney recipients with a stable kidney function (Stable; *n* = 32), kidney recipients with acute rejection at the time of rejection (R0), and 6 and 12 months after rejection (R6 and R12). Data are presented as mean ± SD, \* *p*-value < 0.05, \*\* *p*-value < 0.01, \*\*\* *p*-value < 0.001.

#### *2.4. Circulating LNC-EPHA6 Decreases in the First Year After Acute Rejection*

Since vascular damage persists after a rejection episode, patients with AR were followed longitudinally to study the dynamics of lncRNAs in the first year after AR. Elevated levels of circulating LNC-EPHA6 persisted until six months after AR (*p* < 0.001) and decreased significantly one year after rejection, although LNC-EPHA6 levels at one year after rejection remained slightly higher levels than in stable patients (*p* = 0.03; Figure 2). LIPCAR showed a similar pattern without reaching significance (*p* = 0.16), while LNC-RPS24 increased one year after transplantation (Figure 2). eGFR did not change significantly the year after AR.
