Abstract
We thank Saifu Yin for the comments.1 As Yin pointed out, we describe a strong association between the development of donor-specific antibody (DSA) post-transplant, histological diagnosis of T cell–mediated rejection (TCMR), and nonadherence to immunosuppression as assessed by calcinuerin inhibitor intrapatient variability.2 We respectfully differ with Yin in his assessment of the results presented. In our article, we presented a logical sequence of analyses and arguments showing that (i) DSA was strongly associated with increased odds of TCMR, (ii) the combination of DSA and TCMR associates with poor graft outcomes when compared with either DSA or TCMR alone, and (iii) of the factors identified to be associated with DSA+TCMR+, immunosuppression nonadherence defined by a high calcinuerin inhibitor intrapatient variability (>35%), which was potentially modifiable, was further explored.
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