{ "docId": "019dd923-622c-750b-8b98-0c85e40ec39b", "docSlug": "9b248b07037e", "documentTitle": "CareDx, Inc. (CDNA)", "authorId": "53_Kerrisdale_Capital", "authorName": "Kerrisdale Capital", "documentKindSlug": "research-note", "documentKindLabel": "Research note", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2019-07-01 00:00:00", "orientation": "portrait", "aspectRatio": 0.77272725, "pageNumber": 9, "pageCount": 29, "prevPage": 8, "nextPage": 10, "slideType": "problem_statement", "function": "diagnose_problem", "density": "dense", "nDataPoints": 0, "notes": "The slide highlights a diagnostic gap in transplant monitoring, setting up a potential need for a more sensitive/specific diagnostic test.", "elementsJson": [ "bullet_list", "paragraph", "footnote" ], "metadataConfidence": 0.9, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b98-0c85e40ec39b/9", "deckHref": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b", "deckJsonHref": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b98-0c85e40ec39b#slide-9", "components": [ { "bbox": null, "kind": "callout", "text": "The biopsy of the kidney tissue by a pathologist is the ultimate arbiter of whether the patient is suffering from transplant rejection.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-203e-77ad-a69c-ed5fd6fe3f89", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.12, "y": 0.09 }, "kind": "list", "text": "T-Cell-Mediated Rejection (TCMR/CMR) - also called cellular rejection... Acute Antibody-Mediated Rejection (AMR/ABMR)... Chronic AMR - is similar to acute AMR...", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "56849f05-f99f-4f37-b536-4aefc2c57dda", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.12, "y": 0.37 }, "kind": "paragraph", "text": "The precise parameters of a kidney rejection episode... are only discoverable via biopsy. But kidney biopsies are not normally a routine monitoring mechanism because performing them regularly on every single transplant recipient is seen as overkill.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "5ecad31e-bf72-44f1-945f-1feeea60e77d", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.78, "x": 0.12, "y": 0.55 }, "kind": "paragraph", "text": "But relying on kidney function as the first sign that a transplant might be rejecting is less than ideal. First of all, it's not very \"specific,\" which means that decreased kidney function could be a sign of rejection, but it could also be a sign of other problems such as dehydration, infection, or other kidney injuries.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "67b0aac9-3f34-4ca2-a743-3be43f6eef14", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.12, "y": 0.75 }, "kind": "paragraph", "text": "Kidney function is also not a very \"sensitive\" indicator of kidney rejection, which means that there's a lot of rejection taking place that doesn't get picked up by serum creatinine measurement.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "9feb33ad-3fcd-4fe3-82c8-d9de89a5f737", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.08, "w": 0.78, "x": 0.12, "y": 0.85 }, "kind": "source-note", "text": "8 Generally indicated on a biopsy by a phenomenon called C4d staining\n9 Protocol biopsies are biopsies performed routinely for screening purposes...", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8c35cf4f-6fc4-42e4-b943-3a8906a1e44d", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.06, "y": 0.04 }, "kind": "title", "text": "KerrisdaleCapital", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "75c3b303-c212-449b-9be8-73e4a0a9d541", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.12, "y": 0.33 }, "kind": "title", "text": "Diagnosing Rejection", "attrs": null, "subkind": "subtitle", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "337db765-568a-4080-8487-f18846647746", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "diagnostic-test", "slug": null, "matchId": "b99caee7-f144-48ae-af45-f45cc17b17e9", "evidence": "The slide evaluates the sensitivity and specificity of current diagnostic methods for kidney rejection.", "confidence": 0.8 } ], "arcBeats": [ { "to": 10, "from": 9, "beatId": "560a7993-5aa9-4db0-bc40-0dafc8803d9f", "arcName": "Problem-Agitate-Solution", "arcSlug": "problem-agitate-solution", "beatName": "Problem Statement", "beatSlug": null, "evidence": "Slides 9-10 introduce the problem of T-Cell-Mediated Rejection (TCMR/CMR) and Cell-Free DNA", "position": 0, "confidence": 0.8, "parentBeatName": null, "parentBeatSlug": null } ], "loops": [ { "to": 26, "from": 4, "name": "Cost Of Inaction", "slug": "27-cost-of-inaction", "bestFor": "Urgent budget requests, compliance, risk mitigation", "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", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "confidence": 0.7, "description": "Quantify what happens if the audience does nothing" } ], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }