GEOapplication/xmlftp://ftp.ncbi.nlm.nih.gov/geo/series/GSE327nnn/GSE327889/primaryOK200TranscriptomicsHomo sapiensExpression profiling by arrayhttps://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE327889GEOGSEfalseMolecular Rejection Signatures in Pancreas Transplant BiopsiesThis retrospective, single-center study included 124 pancreas allograft biopsies obtained between April 2019 and May 2025. Biopsies were analyzed using a kidney-derived Molecular Microscope® Diagnostic System (MMDx) classifier, and molecular classifications were compared with histology and related to pancreas graft survival. MMDx classified 93 biopsies (75%) as no rejection, 13 (10%) as subthreshold rejection, and 18 (15%) as rejection, whereas histology identified rejection in 65 of 112 biopsies (58%) and 25 (22%) as indeterminate cases. Concordance between histology and MMDx was low (Cohen’s κ = 0.14, p<0.001). Acute cellular histologic grading correlated strongly with multiple molecular scores, including interstitial inflammation (ρ=0.60, p=3.4×10⁻12), TCMR (ρ=0.55, p<3.2×10⁻10), acute kidney injury (ρ=0.48, p=7.4×10⁻8), and overall inflammation (ρ=0.46, p=4.4×10⁻7). Both subthreshold rejection (HR=4.41, 95% CI 1.29–15.1, p=0.018) and MMDx-defined rejection (HR=6.52, 95% CI 2.36–18.03, p=0.0003) were associated with significantly worse three-year graft survival compared to no rejection, whereas histologic classification showed no significant prognostic impact. Molecular assessment using a kidney-derived MMDx classifier provides complementary prognostic information beyond histology in pancreas transplantation.2026/06/30GSE327889GSM9667883GSM9667884GSM9667885GSM9667886GSM9667880GSM9667881GSM9667882GSM9667803GSM9667804GSM9667805GSM9667806GSM9667887GSM9667888GSM9667800GSM9667889GSM9667801GSM9667769GSM9667802GSM9667807GSM9667808GSM9667809GSM9667773GSM9667774GSM9667775GSM9667776GSM9667890GSM9667770GSM9667891GSM9667892GSM9667771GSM9667772GSM9667814GSM9667815GSM9667816GSM9667817GSM9667810GSM9667777GSM9667778GSM9667811GSM9667812GSM9667779GSM9667813GSM9667861GSM9667862GSM9667863GSM9667864GSM9667860GSM9667869GSM9667865GSM9667866GSM9667867GSM9667868GSM9667872GSM9667873GSM9667874GSM9667875GSM9667870GSM9667871GSM9667876GSM9667877GSM9667878GSM9667879GSM9667840GSM9667841GSM9667842GSM9667847GSM9667848GSM9667849GSM9667843GSM9667844GSM9667845GSM9667846GSM9667850GSM9667851GSM9667852GSM9667853GSM9667858GSM9667859GSM9667854GSM9667855GSM9667856GSM9667857GSM9667818GSM9667819GSM9667784GSM9667785GSM9667786GSM9667787GSM9667820GSM9667780GSM9667781GSM9667782GSM9667783GSM9667825GSM9667826GSM9667827GSM9667828GSM9667821GSM9667788GSM9667789GSM9667822GSM9667823GSM9667824GSM9667829GSM9667790GSM9667795GSM9667796GSM9667830GSM9667797GSM9667798GSM9667831GSM9667791GSM9667792GSM9667793GSM9667794GSM9667836GSM9667837GSM9667838GSM9667839GSM9667832GSM9667799GSM9667833GSM9667834GSM966783516043327889Homo sapiens