Loupy A, Aubert O, Orandi BJ, et al. - Through an international cohort study of three cohorts comprising 7,557 kidney transplant recipients from 10 academic medical centers from Europe and the United States, researchers developed and verified an integrative system to prognosticate long term kidney allograft failure. Following a median posttransplant follow-up time of 7.12 years, a total of 1,067 allografts failed. Eight functional, histological, and immunological prognostic factors in the derivation cohort were independently correlated with allograft failure and were then combined into a risk prediction score (iBox). This score displayed accurate calibration and differentiation. The performance of the iBox was also validated in the validation cohorts from Europe and the US. The iBox system showed accuracy when assessed at various times of assessment posttransplant, was validated in various clinical scenarios including the type of immunosuppressive regimen used and response to rejection therapy, and exceeded former risk prediction scores as well as a risk score based singularly on functional parameters including estimated GFR and proteinuria. Ultimately, the accuracy of the iBox risk score in prognosticating long term allograft loss was validated in the three randomized controlled trials. An integrative, reliable, and promptly implementable risk prediction score for kidney allograft failure that has been developed, which explicates generalisability across centers worldwide and common clinical scenarios. The iBox risk prediction score may help to guide the monitoring of patients and further improve the design and development of a valid and early surrogate endpoint for clinical trials.