2.5.2. T-Cell-Mediated Rejection Diagnosis

The previously mentioned study by Tinel et al. also provided separate outcome analysis for CXCL9 and CXCL10, with the best performance for TCMR diagnosis with a NPV of 98% and a very good AUC of 0.81 [16]. Also of note, CCL2, at a threshold level of 198 pg/mL, yielded very good performance (AUC 0.81) for TCMR identification among a population of 300 normal and dysfunctional grafts in the study by Raza et al. [43]. Urinary exosome proteins were investigated in two case-control studies for the diagnosis of TCMR. Lim et al. found significantly higher urinary tetraspanin-1 (TSPAN1) and hemopexin (HPX) expression levels in TCMR patients with good diagnostic performance (AUC 0.74) [28], while Park et al. reported the initial results of an optimized integrated kidney exosome analysis (iKEA) able to distinguish TCMR from normal histology patients, with a very good performance (AUC 0.84) in a small validation cohort [33].
