Urinary CXCL9 for kidney allograft rejection: A systematic review and meta-analysis of diagnostic performance across clinical scenarios
Abstract
INTRODUCTION
Early rejection detection is crucial for kidney transplant success, yet protocol biopsies are invasive and impractical for routine monitoring. Urinary Chemokine (C-X-C motif) ligand 9 (CXCL9), which recruits T-cells during rejection, shows promise as a non-invasive alternative, but its diagnostic performance across clinical contexts requires validation.
METHODS
We searched PubMed, EMBASE, Cochrane Library, Web of Science, and China National Knowledge Infrastructure through September 2025 for studies evaluating urinary CXCL9 in biopsy-proven rejection. After quality assessment with QUADAS-2, we calculated pooled sensitivity, specificity, and diagnostic odds ratios using bivariate random-effects models, with subgroup analyses by clinical scenario (predictive monitoring vs. diagnostic workup) and confounding factors (BK viremia, urinary infections).
RESULTS
Ten studies (875 patients) met inclusion criteria. Pooled sensitivity was 0.82 (95% CI: 0.75-0.87), specificity 0.82 (0.74-0.88), DOR 20.66 (11.16-38.24), and AUC 0.83 (0.79-0.86). Performance was notably better in stable patients undergoing predictive monitoring (sensitivity 0.88, specificity 0.86, DOR 43.09) than in symptomatic patients (sensitivity 0.79, specificity 0.71, DOR 10.60). BK viremia (BKV) and urinary tract infections (UTI) markedly increased false-positives. Heterogeneity was substantial (I2 = 80%), driven mainly by assay platform differences and lack of standardized cutoffs.
CONCLUSION
Urinary…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 875 participants or records.
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