To construct a nomogram with high-frequency shear wave elastography (SWE) as a noninvasive method to accurately assess chronic changes in renal allografts.

A total of 191 renal transplantation patients (127 cases in the training group and 64 cases in the verification group) were included in this study. All patients received conventional ultrasound and high-frequency SWE examination, followed directly by biopsy the next day. The chronic changes were divided into mild, moderate, and severe. Multivariate logistic analyses were used to select significant variables, which were used to develop the nomogram. Nomogram models were assessed by receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

The cutoff value of SWE in mild, moderate, and severe chronic changes was 18.9, 22.5, and 27.6 kPa, respectively. The areas under the curve (AUCs) of SWE in the differential diagnosis of mild and moderate to severe chronic changes and mild to moderate and severe chronic changes were 0.817 and 0.870, respectively. Multivariate analysis showed that time since transplantation, proteinuria, glomerular filtration rate, echogenicity, and SWE were independent diagnostic factors for moderate to severe chronic changes (all p < 0.05); thus, a nomogram was successfully developed. The AUCs of the nomogram in the training and validation groups were 0.905 and 0.938, respectively. The high agreement between the model predictions and the actual observations was confirmed by calibration plot and DCA.

Based on SWE, the nomogram provided an insightful and applicable tool to evaluate chronic changes in renal allografts.

• In kidney transplantation, compared with acute changes, chronic changes are significantly correlated with cortical stiffness.

• SWE shows good performance in identifying mild to moderate and severe chronic changes, with an AUC of 0.870.

• Time since transplantation, proteinuria, glomerular filtration rate, echogenicity, and SWE are independent diagnostic factors for moderate to severe chronic changes in renal allografts.