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Cover page carries the full SCQA. Thesis rests on clinical-literature critique (Bloom/DART/KOAR) plus sum-of-parts valuation benchmarked to Natera. Author is 'Kerrisdale Capital Management'; no named signatory on cover or closing. Quotes CEO Peter Maag and CareDx marketing materials to expose over-claims ('precise, actionable results', 'reduce invasive biopsies'). Uses footnoted references to JASN, Am J Transplant, UCSF cost studies; tone is clinically technical rather than theatrical.", "kpisCited": [ { "detail": "~41% of rejection episodes missed in Bloom et al. DART sub-study", "metric": "AllSure rejection miss rate" }, { "detail": "Only 3.9% of reference cohort flagged vs. 15-35% true subclinical rejection rate", "metric": "Subclinical rejection detection" }, { "detail": "20-30% per quarter, ~70% annually, vs. company-disclosed 10%/quarter", "metric": "Surveillance patient attrition" }, { "detail": "Over 90% of revenue from patients on a surveillance protocol", "metric": "Share of AllSure revenue from protocol/surveillance" }, { "detail": "18.4x; 47.7x on AllSure TTM, 33.3x on Q1 annualized", "metric": "EV/revenue (trailing)" }, { "detail": "$2,840 per test, likely to compress toward ~$800 under PAMA", "metric": "Medicare reimbursement per AllSure test" }, { "detail": "CareDx claims $2bn; Kerrisdale pegs realistic ceiling at ~$500m (best case)", "metric": "TAM for AllSure" }, { "detail": "AllSure ~$500-600 vs. Natera's targeted Prospera COGS <$200", "metric": "Per-test COGS" }, { "detail": "$11.22 implied vs. $37.40 trading price (-70%)", "metric": "Implied per-share value vs. current" } ], "closingAsk": "Sell or short CDNA: AllSure is a clinically ineffective test whose revenue base, Medicare coverage and TAM are unsustainable, implying ~70% downside to ~$11 per share.", "extraction": { "at": "2026-04-22 20:29:22+00", "model": "unknown-legacy", "runId": null, "seconds": 176.35623, "promptVersion": null }, "scqaReward": "Valuing CareDx like Natera yields an implied share value of $11.22 against a ~$37 market price, roughly 70% downside from current levels.", "thesisTypes": [ "fraud_exposure", "undervaluation" ], "top3Reasons": [ "AllSure misses ~40% of kidney rejections, a fatal diagnostic flaw", "Surveillance patients attriting at 20-30% per quarter, ~70% annually", "Competing cfDNA and GEP tests plus Medicare review threaten coverage" ], "scqaSituation": "CareDx is a $1.7bn diagnostics company whose stock has risen 30x in two years on enthusiasm for AllSure, a dd-cfDNA blood test intended to detect kidney-transplant rejection earlier than serum creatinine.", "thesisSummary": "CareDx trades at 18.4x trailing revenue on the back of AllSure, a dd-cfDNA kidney-transplant rejection test launched under provisional Medicare coverage in late 2017. Kerrisdale argues AllSure is clinically ineffective: the pivotal Bloom study shows it misses roughly 40% of rejection episodes and is structurally incapable of identifying T-cell-mediated rejection, the most common form. Revenue is overwhelmingly driven by protocol usage inside large, Medicare-reimbursed clinical studies, yet surveillance patients are churning at 20-30% per quarter (~70% annually), signaling that physicians are not finding the test useful. Natera's Prospera and Transplant Genomics' TruGraf are poised to take share just as MolDX revisits coverage tied to the KOAR trial. Valuing CareDx like Natera yields ~$11/share versus $37, implying ~70% downside.", "primaryDemands": [ "Short CareDx shares ahead of deteriorating AllSure economics", "Reassess Medicare coverage risk and TAM assumptions" ], "scqaResolution": "Short CDNA: competing cfDNA (Natera Prospera) and GEP (TruGraf) tests are entering the market, MolDX will scale coverage back to narrow AMR use cases, and AllSure's inflated TAM will collapse.", "thesisOneLiner": "CareDx is a $1.7bn story built on AllSure, a cfDNA kidney-rejection test that misses 40% of rejections and faces 70% annual patient attrition, competition and Medicare reset — ~70% downside.", "precedentsCited": [ "ImmuMetrix sale to CareDx (2014, $17m)", "Natera Prospera cfDNA development and MolDX draft LCD", "TruGraf (Transplant Genomics) prospective validation" ], "scqaComplication": "AllSure misses ~40% of rejections in the pivotal Bloom study, cannot detect T-cell-mediated rejection, and surveillance patients are attriting at 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INVESTMENT HIGHLIGHTS... 3\nII. COMPANY OVERVIEW... 8\nIII. CLINICAL DATA SHOW THAT ALLOSURE IS INSENSITIVE... 12\nIV. ALLOSURE REVENUES OVERWHELMINGLY COME FROM PROTOCOL USAGE... 20\nV. ALLOSURE IS VULNERABLE... 23\nVI. 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In CareDx's DART clinical trial, only 3.9% of a reference cohort of patients who exhibited no signs of impaired kidney function tested positive for kidney rejection using AlloSure.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.568+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1590d0dd-ba9f-4939-b933-9c5b384f5183", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.78, "x": 0.11, "y": 0.29 }, "kind": "paragraph", "text": "More recent studies confirm the problems with AlloSure implicit in the DART trial and cast further doubt on the accuracy of the test, strongly suggesting that AlloSure is structurally incapable of identifying T-Cell-Mediated Rejection (TCMR).", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.568+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "25351198-d677-42ef-b5f6-d24650dbc976", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.09 }, "kind": "paragraph", "text": "rejection (high false positive rate), but AlloSure presents the much more severe problem of underdiagnosing rejection (high false negative rate).", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.568+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "72553103-5758-45d3-b362-0dcd451cdf87", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.38 }, "kind": "paragraph", "text": "AlloSure's commercial success is unsustainably built on collapsing clinical-study usage and conditional Medicare coverage. If AlloSure is such a poor biomarker, how did it reach a ~$45 million annual revenue run rate in less than 18 months?", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.568+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "794dcbc7-6a05-4071-abc5-b732fdb211a5", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.22 }, "kind": "paragraph", "text": "But studies documenting the results of surveillance biopsies reveal that the subclinical rejection rate ranges from 15-35%. In other words, AlloSure misses the overwhelming majority of subclinical rejection episodes.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.568+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "89a77f64-5154-4ea7-8b58-e419b0ab7ef3", "parentComponentId": null }, { "bbox": { "h": 0.11, "w": 0.78, "x": 0.11, "y": 0.52 }, "kind": "paragraph", "text": "MolDX, short for Molecular Diagnostic Services, is a program run by Palmetto GBA... To get a Local Coverage Determination (LCD) from MolDX, a test must pass a technical assessment.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.568+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8a218b43-c44e-43dd-a3ec-bf1182a31d30", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "CareDx can technically claim that AlloSure is “more accurate” than serum creatinine measurement because it has a lower rate of false positives. But accuracy is not the goal of rejection testing, rather, detecting rejection is. — Footnote 2", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:26:44+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-203e-77ad-a69c-66bfafbd07e6", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.11, "y": 0.85 }, "kind": "source-note", "text": "CareDx can technically claim that AlloSure is “more accurate” than serum creatinine measurement because it has a lower rate of false positives. But accuracy is not the goal of rejection testing, rather, detecting rejection is.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.568+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "807d7837-db30-4c30-855f-7eb88091bec4", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.78, "x": 0.11, "y": 0.89 }, "kind": "source-note", "text": "Bromberg JS, Brennan DC, Poggio E, et al. Biological Variation of Donor-Derived Cell-Free DNA in Renal Transplant Recipients: Clinical Implications. J Appl Lab Med 2017; 2:309", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.568+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dfd607ff-1580-4b2d-aacc-dbe766ec7517", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [ { "to": 26, "from": 4, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "6ece1bb9-6dc2-4b36-a983-1e6b3a2a754d", "evidence": "The document emphasizes the risks of not acting on AlloSure's ineffectiveness", "position": 0, "objective": "Highlight the cost of inaction for investors", "confidence": 0.7, "extraction": { "at": "2026-07-16 21:59:21.914563+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 5, "type": "appendix", "title": "This is a page from a research report rather than a standard presentation slide, containing dense narrative text and footnotes.", "function": "analyze_data", "rawType": "other", "block": null, "metadata": { "slideType": "other", "slideTypeCanon": { "name": "Other (fallback)", "slug": "other", "status": "active", "canonId": "019de52d-0af5-71ed-83de-d51ae245fc43", "version": 1, "description": null }, "function": "analyze_data", "functionCanon": { "name": "Analyze data", "slug": "analyze_data", "status": "active", "canonId": "019de52d-1590-7413-8c82-cc218cff40b4", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 93, "componentCount": 10, "textChars": 4004, "nDataPoints": 11, "notes": "This is a page from a research report rather than a standard presentation slide, containing dense narrative text and footnotes.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 0.9, "extraction": { "model": "google/gemini-3.5-flash", "runId": null, "at": "2026-07-17 03:53:49.986+00", "seconds": 9.397, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b98-0c85e40ec39b/5", "deck": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b", "deckAnchor": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b#slide-5", "deckJson": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Given the historical disclosure of quarterly surveillance patients, and recent disclosures regarding the total number of patients who have ever been provided AlloSure results, we calculate an attrition rate for surveillance patients of approximately 20-30% per quarter, or a staggering 70% annually.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:26:45+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-203e-77ad-a69c-bba4d21c73af", "parentComponentId": null }, { "bbox": { "h": 0.015, "w": 0.405, "x": 0.118, "y": 0.895 }, "kind": "disclaimer", "text": "4 11/9/2017 – CareDx Fiscal 2017 Third Quarter Earnings Call", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": "disclaimer", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:53:49.986+00", "model": "google/gemini-3.5-flash", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2e7dafa6-5df3-48dc-b60c-ec8ae51d53a1", "parentComponentId": null }, { "bbox": { "h": 0.024, "w": 0.208, "x": 0.062, "y": 0.038 }, "kind": "image", "text": "Kerrisdale Capital", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Logo", "slug": "logo", "status": "active", "canonId": "019de52c-fdaf-743d-94c4-d7c6a0e55302", "version": 1, "description": null }, "framework": null }, "subkind": "logo", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:53:49.986+00", "model": "google/gemini-3.5-flash", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e3a304f3-c88f-4107-8f42-958a79b77838", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "patient attrition rate: 70%", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:26:45+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-203e-77ad-a69c-c13d925782a1", "parentComponentId": null }, { "bbox": { "h": 0.072, "w": 0.764, "x": 0.118, "y": 0.092 }, "kind": "paragraph", "text": "prospective clinical studies will demonstrate improved patient outcomes. Continued coverage for AlloSure testing is dependent on annual review by this contractor of such data and publications.\" [emphasis added] For now, though, AlloSure is covered and reimbursable for any kidney transplant recipient covered by Medicare.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:53:49.986+00", "model": "google/gemini-3.5-flash", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3fa470af-aaf8-40e7-b50e-9222ff358a07", "parentComponentId": null }, { "bbox": { "h": 0.192, "w": 0.764, "x": 0.118, "y": 0.665 }, "kind": "paragraph", "text": "As with the routine screening of transplant recipients (see below), AlloSure usage is being studied on a protocol basis, with CareDx routinely disclosing on earnings calls the number of patients on an AlloSure surveillance protocol. Recently, the company has disclosed a quarterly attrition rate of 10% for these surveillance patients. While that still implies an incredible 35% annual drop-out rate, we believe that the real attrition rate is much higher. Given the historical disclosure of quarterly surveillance patients, and recent disclosures regarding the total number of patients who have ever been provided AlloSure results, we calculate an attrition rate for surveillance patients of approximately 20-30% per quarter, or a staggering 70% annually. Consider that CareDx has provided results to \"over 8,000 patients\" in the span of 6 quarters, and yet only about 3600 patients are currently on an AlloSure surveillance protocol.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:53:49.986+00", "model": "google/gemini-3.5-flash", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9eb6c3cc-91b0-410d-b93c-3357a803138b", "parentComponentId": null }, { "bbox": { "h": 0.225, "w": 0.764, "x": 0.118, "y": 0.188 }, "kind": "paragraph", "text": "That LCD went into effect on October 2, 2017, which partly explains the AlloSure revenue ramp that started in the fourth quarter of 2017. But it's also worth putting AlloSure into the more general context of organ rejection research. The transplant community has always dreamed of a noninvasive \"silver bullet\" to detect organ rejection, and the genomic revolution has brought with it hope that such a test could be developed. AlloSure measures the quantity of donor-derived cell-free DNA (dd-cfDNA) in the patient's blood stream, and the hypothesis that cfDNA might signal organ rejection was first advanced as far back as 1998. Research on the matter started gaining momentum in 2011 and, since then, small studies of cfDNA as a rejection marker in heart, lung, and kidney transplants showed promise but were inconclusive. Even the March 2017 flagship paper that arose out of CareDx's DART study was small (102 patients, only 27 of whom were diagnosed with rejection) and while \"promising\" (in the words of MolDX), it was far from conclusive.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:53:49.986+00", "model": "google/gemini-3.5-flash", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d8001d7b-8081-4e46-a7cb-be9ab1db078e", "parentComponentId": null }, { "bbox": { "h": 0.208, "w": 0.764, "x": 0.118, "y": 0.435 }, "kind": "paragraph", "text": "The LCD from MolDX in late 2017 essentially subsidized further studies of cfDNA by providing reimbursement for AlloSure, which flung open the door for large-scale studies to take place. cfDNA, which had been the subject of intense speculation and curiosity for a decade, could now be studied as a noninvasive rejection biomarker in large numbers and at negligible cost. On top of the latent demand for studying cfDNA, CareDx shrewdly provided financial support and funding to renowned transplant nephrologists in over two dozen of the largest clinics nationwide, ensuring a steady stream of multi-year studies that would provide \"recurring\" demand for AlloSure tests. 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One of these is a dd-cfDNA test from Natera, a company that has a long history of using cfDNA in prenatal applications. We are skeptical about the ability of cfDNA to significantly impact kidney transplant diagnostics, but Natera may be able to measure cfDNA more accurately, and has a cost structure low enough to significantly undercut AlloSure on price. 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It is generally believed that enough time spent in a state of subclinical rejection eventually results in chronic AMR or severe TCMR.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:22.881+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "40e27ac1-6dfc-4783-9d12-57ebe6a06045", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.78, "x": 0.11, "y": 0.09 }, "kind": "paragraph", "text": "frequency of rejection diagnoses that result from these biopsies, and it's clear that plenty of rejection episodes happen with no falloff in kidney function.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:22.881+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a86dad66-bafd-420c-a024-4fc1f6ee8c22", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Mehta R, Sood P, Hariharan S. 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Subclinical Rejection in Renal Transplantation: Reappraised. Transplantation. 2016;100(8):1610-1618. 11 Ibid. See also Friedewald, JJ, Kurian, SM, Heilman, RL, et al. Development and clinical validity of a novel blood-based molecular biomarker for sub-clinical acute rejection following kidney transplant. Am J Transplant. 2019; 19: 98-109.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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But “accuracy” is a statistical term, an artifact of the number of false positives and false negatives. Accuracy doesn’t account for the severity of the false result. In the case of kidney rejection, a false negative can result in organ failure, while a false positive means a relatively low-risk, but unnecessary biopsy. You’d rather over-diagnose than under-diagnose given the consequences. Creatinine indeed chalked up lots of false positives in the study (39%), while AlloSure had a lower rate of false positives (39%) and a seemingly low rate of false negatives (16%). CareDx touts the low false negative rate to show that AlloSure can be used to rule out rejection. But that’s incredibly misleading: it’s true that of 77 AlloSure tests that came back negative, “only” 12 tested positive for rejection on biopsy (16%). 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The problem is that the market for AMR monitoring is about 5% of the overall kidney transplant population annually. Even at CareDx's inflated $2,840 per test (which, as we discuss below, we expect will come down dramatically), that leaves a total market size of ~$100 million.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:24.934+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "805530c4-6d54-4281-b77a-1741e03c4230", "parentComponentId": null }, { "bbox": { "h": 0.085, "w": 0.77, "x": 0.118, "y": 0.225 }, "kind": "paragraph", "text": "The other potential use of AlloSure is as a screening test for subclinical AMR in sensitized patients who are at higher risk of AMR in the first place. This market is a bit larger than the population of patients already diagnosed with AMR and could potentially reach about $400 million. The question is: can AlloSure detect subclinical AMR? 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This is data that could help with assessing the utility of AlloSure in subclinical rejection. We suspect that the lack of published data is indicative of AlloSure's ineffectiveness in subclinical rejection.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.539+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "de5680b8-3f01-45bb-8bde-ebc643c0675a", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.14, "y": 0.89 }, "kind": "source-note", "text": "22 The abstract can be found here.", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The sample set in this study was composed of 70 biopsies performed on patients whose blood tests came back positive for DSA, indicating risk of AMR. Of these, 39 biopsies were diagnosed as AMR. Not all the DSA tests were paired with an AlloSure test, but in those that were, AlloSure correctly identified only 43% of rejection cases. Which begs the question – why perform a $2800 AlloSure test when it will miss over half the cases identified by a $755 DSA blood test?", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:25.887+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1ceb759b-b4ae-4df5-bee5-6cf804737680", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.76, "x": 0.12, "y": 0.68 }, "kind": "paragraph", "text": "To summarize: AlloSure is anatomically incapable of detecting the most common form of kidney rejection, TCMR, even in the presence of impaired kidney function. In the case of AMR, it's impossible for AlloSure to be used as a rule-out mechanism in the presence of impaired kidney function or a positive DSA test, so a $2 billion market opportunity built on mass AlloSure screening is, at best, a delusion. Finally, it's almost certain that AlloSure cannot identify subclinical AMR in any systematic way, though it's worth noting that the market for AMR screening is comprised of highly sensitized transplant recipients, which represent – at most – about 15% of the total kidney transplant population.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:25.887+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2be65f80-1e1b-41f3-9cf9-e53e31f3bf1b", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.76, "x": 0.12, "y": 0.36 }, "kind": "paragraph", "text": "Imagine spending $1.4 million on AlloSure tests in the span of 8 months and finding only one incremental case of rejection that's potentially just statistical randomness (in cfDNA sampling).", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:25.887+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fd48ce29-ef22-405e-bdb3-31b205a63cad", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.4, "x": 0.12, "y": 0.32 }, "kind": "source-note", "text": "Source: AST Transplantation Summit Program Guide, Abstract #40", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:25.887+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "277f663d-f885-4cdc-97f6-c67d0ca24ccf", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.76, "x": 0.12, "y": 0.89 }, "kind": "source-note", "text": "23 Based on the granular data reported by the Organ Procurement and Transplantation Network", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"confidence": 0.7, "extraction": { "at": "2026-07-16 21:59:21.914563+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 20, "type": "tension", "title": "The slide uses a narrative structure to undermine the company's growth story by framing it as a 'house of cards'.", "function": "expose_contradiction", "rawType": "thesis_headline", "block": null, "metadata": { "slideType": "thesis_headline", "slideTypeCanon": { "name": "Thesis headline", "slug": "thesis_headline", "status": "active", "canonId": "019de52d-073a-70cb-b9f6-772a597bb5af", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 85, "componentCount": 9, "textChars": 3503, "nDataPoints": 3, "notes": "The slide uses a narrative structure to undermine the company's growth story by framing it as a 'house of cards'.", "elementsJson": [ "headline_text", "paragraph" ], "confidence": 0.95, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:45:26.244+00", "seconds": 5.146, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b98-0c85e40ec39b/20", "deck": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b", "deckAnchor": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b#slide-20", "deckJson": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "CareDx likes to boast that surveillance usage \"helps build the recurring revenue effect of AlloSure\" but we think that it's helped build an AlloSure house of cards.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:26:46+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-203e-77ad-a69e-4fa4c61ff0d4", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.76, "x": 0.12, "y": 0.58 }, "kind": "paragraph", "text": "CareDx was also aided by the unique status of diagnostic tests with regulatory bodies. As a Laboratory Developed Test (LDT), AlloSure didn't need FDA approval; and to obtain payor coverage, CareDx went through MolDX. The MolDX (Molecular Diagnostic Services) program was set up in 2011 to manage the growing number of genetic and molecular diagnostic LDTs and is run under the auspices of Palmetto GBA, a Medicare Administrative Contractor (MAC) in the Southeast. Most other MACs in the country have outsourced LDT coverage decisions to MolDX, so the program is effectively a gateway to national coverage and reimbursement for LDTs. To get a Local Coverage Determination (LCD) from MolDX, a test must pass a technical assessment and demonstrate \"analytical validity, clinical validity, and clinical utility.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1fb6e2fa-d702-49d0-8094-0e22b0f671e0", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.76, "x": 0.12, "y": 0.19 }, "kind": "paragraph", "text": "Despite its fatal flaws, CareDx has been able to generate a lot of buzz regarding AlloSure, successfully steering the test to ~$45 million in annualized revenues as of the most recent fiscal quarter.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4fce973f-2b5e-4cb1-a100-259ff40c85e3", "parentComponentId": null }, { "bbox": { "h": 0.09, "w": 0.76, "x": 0.12, "y": 0.74 }, "kind": "paragraph", "text": "MolDX will typically grant an LCD even with limited evidence of clinical utility, conditional upon further research that's expected to prove clinical utility. That's precisely the case with the LCD for AlloSure, finalized on October 2, 2017, which states that MolDX recognizes that the evidence of clinical utility for the use of AlloSure in its intended use population is promising at the current time. However, this contractor believes that", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "59e992c1-cc21-4c4f-b4ff-12e9f3dfc2ca", "parentComponentId": null }, { "bbox": { "h": 0.16, "w": 0.76, "x": 0.12, "y": 0.32 }, "kind": "paragraph", "text": "To put AlloSure's success in context, recall that cfDNA has been the subject of intense study and speculation in the transplant community for over 20 years. The Quake lab at Stanford lent cfDNA a Silicon Valley halo by publishing a small study of its potential in the heart transplant setting in early 2011, and hundreds of small scale studies followed over the years. Strangely, Quake and Snyder started a company called ImmuMetrix to commercialize cfDNA testing in transplants but sold it to CareDx in 2014 for $17 million in (then-privately-held) stock, apparently judging the opportunity not sufficiently exciting. 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Kidneys are also unique in that medical care for 3 years post-transplant is entirely covered by Medicare, so broad payor coverage for a rejection test would essentially require only Medicare to assent.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9069e357-0a9e-4d38-9eb7-7fa9e3cd6a7e", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.76, "x": 0.12, "y": 0.24 }, "kind": "paragraph", "text": "But the foundation of AlloSure's success is surveillance usage in clinical studies like the ones taking place at Cedars-Sinai and the University of Colorado. CareDx likes to boast that surveillance usage \"helps build the recurring revenue effect of AlloSure\" but we think that it's helped build an AlloSure house of cards.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:26.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c9297815-90ff-412e-ae2c-dca7596a2018", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "recognizes that the evidence of clinical utility for the use of AlloSure in its intended use population is promising at the current time. 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By our latest count, CareDx has financial relationships – research funding, consulting agreements, honoraria, and/or speaker fees – with transplant physicians in clinics comprising 23% of the total kidney transplant volume in the US. There’s nothing necessarily nefarious about this, but it certainly helps when you consider that CareDx’s business model is built on populating patient registries in order to study AlloSure as a surveillance mechanism. 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This was the first time that a “promising” noninvasive biomarker for rejection could be studied at scale, and at no cost to the provider. In fact, the more widely studied, the more revenue the provider would be generating, as every test would be reimbursed by Medicare at a rate of $2,840. 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The annual cost of medical care post-transplant is about $25 thousand dollars on average. 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}, { "bbox": { "h": 0.185, "w": 0.764, "x": 0.118, "y": 0.331 }, "kind": "paragraph", "text": "The trial results will also have regulatory implications. 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Even in the absence of poor trial results and massive attrition, that proposition seems ridiculous.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:25.494+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "337fa380-e527-49e2-81b1-257555e6140d", "parentComponentId": null }, { "bbox": { "h": 0.185, "w": 0.764, "x": 0.118, "y": 0.146 }, "kind": "paragraph", "text": "But those trial results are important in quantifying the realistic TAM for AlloSure because they clarify the potential use cases for dd-cfDNA. It's pretty clear that AlloSure can't be used to detect or rule out rejection when used as a screening test, so estimating a TAM based upon its use in that capacity – as CareDx does – is fanciful. Given the potential utility of cfDNA in the context of AMR, the two use cases discussed previously – AMR monitoring and, much more speculatively, AMR screening – amount to a TAM of ~$500 million in the best case. 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In addition, the Authors may benefit from any change in the valuation of any other companies, securities, or commodities discussed in this document. Analysts who prepared this report are compensated based upon (among other factors) the overall profitability of the Authors' operations and their affiliates. The compensation structure for the Authors' analysts is generally a derivative of their effectiveness in generating and communicating new investment ideas and the performance of recommended strategies for the Authors. This could represent a potential conflict of interest in the statements and opinions in the Authors' documents.\n\nThe information contained in this document may include, or incorporate by reference, forward-looking statements, which would include any statements that are not statements of historical fact. Any or all of the Authors' forward-looking assumptions, expectations, projections, intentions or beliefs about future events may turn out to be wrong. These forward-looking statements can be affected by inaccurate assumptions or by known or unknown risks, uncertainties and other factors, most of which are beyond the Authors' control. Investors should conduct independent due diligence, with assistance from professional financial, legal and tax experts, on all securities, companies, and commodities discussed in this document and develop a stand-alone judgment of the relevant markets prior to making any investment decision.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:24.306+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d0a63ec7-117c-49aa-8507-0eb9ec2ee2cb", "parentComponentId": null }, { "bbox": { "h": 0.022, "w": 0.157, "x": 0.06, "y": 0.038 }, "kind": "image", "text": "KerrisdaleCapital", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Logo", "slug": "logo", "status": "active", "canonId": "019de52c-fdaf-743d-94c4-d7c6a0e55302", "version": 1, "description": null }, "framework": null }, "subkind": "logo", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:24.306+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "38e75318-980a-4ac1-81d0-62c8f4cf64ce", "parentComponentId": null }, { "bbox": { "h": 0.011, "w": 0.774, "x": 0.113, "y": 0.945 }, "kind": "paragraph", "text": "Kerrisdale Capital Management, LLC | 1212 Avenue of the Americas, 3rd Floor | New York, NY 10036 | Tel: 212.792.7999 | Fax: 212.531.6153", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:45:24.306+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c2a17b9e-103f-4a8a-9437-9e16d65a88be", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true } ], "arcBeats": [ { "from": 9, "to": 10, "label": "Problem Statement", "description": "Slides 9-10 introduce the problem of T-Cell-Mediated Rejection (TCMR/CMR) and Cell-Free DNA" }, { "from": 12, "to": 16, "label": "Villain Critique", "description": "Slides 12-16 critique AlloSure's clinical data and utility" }, { "from": 13, "to": 14, "label": "Expose Contradiction", "description": "Slides 13-14 expose contradictions in AlloSure's clinical data" }, { "from": 20, "to": 21, "label": "Thesis Headline", "description": "Slides 20-21 present the thesis on AlloSure's revenue and vulnerability" } ], "loops": [ { "from": 4, "to": 26, "label": "Cost Of Inaction", "description": "Highlight the cost of inaction for investors" }, { "from": 20, "to": 25, "label": "Quick Win Big Bet", "description": "Present a big bet on AlloSure's vulnerability" } ] }