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Abstract

Objectives: Prognostic implications of early protocol biopsies have been studied; however, the value of late protocol biopsy in predicting graft outcome has not been well defined. Here, we compared the effects of early and late protocol biopsy histologic findings in stable kidney allografts and aimed to understand the significance of "borderline" rejection on allograft function. Materials and Methods: We studied 261 biopsies from 159 renal transplant recipients who were on a steroidfree, calcineurin inhibitor and mycophenolate mofetil regimen and who received transplants between 2004 and 2012 with mean follow-up of 5 years. Early (between 3 and 9 mo) and subsequent late (between 12 and 24 mo) protocol biopsies were performed. Biopsies were classified as normal, interstitial fibrosis and/or tubular atrophy, subclinical acute rejection with interstitial fibrosis and/or tubular atrophy, and borderline rejection with interstitial fibrosis and/or tubular atrophy. A linear mixed-effects model was used to determine the effects of early and late protocol biopsies on estimated glomerular filtration rate changes, with baseline time for estimated glomerular filtration rate fixed at 12 months. Results: The adjusted model showed that estimated glomerular filtration rate at 3 months, donor age, delayed graft function, and early protocol biopsies were associated with baseline estimated glomerular filtration rate at 12 months. Estimated glomerular filtration rate changes over time were associated with findings of interstitial fibrosis and/or tubular atrophy at early biopsy and subclinical acute rejection and borderline rejection at late biopsy. At last follow-up, final estimated glomerular filtration rate was significantly associated with interstitial fibrosis and/or tubular atrophy at early biopsy and with subclinical acute rejection at late biopsy. Conclusions: Although early protocol biopsy predicted baseline estimated glomerular filtration rate, late biopsy was important for predicting changes in function over time. In addition, a diagnosis of "borderline" rejection on protocol biopsies predicted long-term graft function.

Non-traditional risk factors of progression of chronic kidney disease in adult population: a scoping review

“…It is important for health professionals to attend to these patients from early detection since the costs in the different levels of care for kidney patients are high, aside from how significantly their quality-oflife decreases, both for patients and their family members involved in the process (57)(58)(59).…”

“…This practice is expensive, but it could contribute to the problem that has developed when this paper was written, in order to identify some causes that have been neglected, which are important in the development of ESRD. The public health system should propose alternatives that help to identify these factors that would undoubtedly assist in explaining a portion of this great problem (58).…”

Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades

“…Although this allows early detection of rejection and tubular atrophy, the effect on long term graft survival remains unclear. Most studies showed comparable short term results in both patients that had protocol biopsies and those that had biopsies on indication of clinical symptoms (206). However, a recent prospective study revealed children who underwent protocol biopsies to have better renal function on the long term than the control group (205).…”