The authors reply

Abstract

Clearly, IPV > 35% is a risk factor for both DSAþTCMRþ and graft loss. That means IPV > 35%, as a confounding factor, should be analyzed in the Cox regression analysis to explore the independent effect of DSAþTCMRþ and IPV on graft survival. However, the author seems to ignore IPV in the Cox analysis intentionally, but all other risk factors in Table 3 are analyzed. This raises doubts about the authenticity of the results, and it remains unclear whether DSAþTCMRþ alone would carry a significant graft loss risk. Considering that previous studies have shown that nonadherence is independently associated with worse clinical outcomes, I believe it is more clinically relevant to explore the independent impact of DSA. Hence, I suggest that a multivariate analysis, including the identified factor of nonadherence, should be performed. Also, considering the sample size, propensity score-matched analysis may help achieve the balance of baseline characteristics, which is also a standard method to eliminate the influence of confounding factors. 4