AUTHOR=Häseli Alain M. , Leuzinger Karoline , Diebold Matthias , Wehmeier Caroline , Handschin Joëlle , Amico Patrizia , Dickenmann Michael , Cippà Pietro E. , Hopfer Helmut , Hirt-Minkowski Patricia , Schaub Stefan 
  
TITLE=Urinary CXCL10 for detection of rejection and infection at 1-year posttransplant
  
JOURNAL=Transplant International
  
VOLUME=Volume 39 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.17130
  
DOI=10.3389/ti.2026.17130
  
ISSN=1432-2277
  
ABSTRACT=Urinary CXCL10 chemokine levels correlate with inflammatory processes in the reno-urinary tract after kidney transplantation. The aim of this study was to investigate the diagnostic characteristics of urinary CXCL10/creatinine ratio to detect major inflammatory processes (i.e., subclinical rejection, relevant JC/BK polyomavirus DNAuria, or significant leukocyturia) in 405 stable renal allograft recipients with surveillance biopsies at 1 year posttransplant. Urinary CXCL10/creatinine had a significantly higher area under the curve (AUC) than serum creatinine or proteinuria (0.786 vs. 0.499 vs. 0.636; both p < 0.0001) for detection of inflammatory processes. The highest AUC was observed for the detection of BK polyomavirus DNAuria (0.936), but it was lower for detection of subclinical rejection (0.703). At an arbitrary rule-out cutoff (CXCL10/creatinine <3 ng/mmol; 59% of all patients; negative likelihood ratio 0.36), 51% of surveillance biopsies could be safely deferred, and the risk of subclinical rejection decreased from 15.8% to 5.4%. At an arbitrary rule-in cutoff (CXCL10/creatinine >10 ng/mmol; 12% of all patients; positive likelihood ratio 12.92), absence of any inflammatory pathologies was only 2%. These data support urinary CXCL10/creatinine measurements at 1-year posttransplant in stable allografts to detect inflammatory processes and guide further diagnostics. The preliminary cutoffs require external validation.