Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates

Furness, Peter; Philpott, Carl; Chorbadjian, Mary T; Nicholson, Michael L.; Bosmans, Jean‐Louis; Corthouts, B.; Bogers, Johannes; Schwarz, Anke; Gwinner, Wilfried; Haller, Hermann; Mengel, Michael; Serón, Daniel; Moreso, Francesc; Cañas, Conception

doi:10.1097/01.tp.0000082542.99416.11

Cited by 202 publications

(172 citation statements)

References 11 publications

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“…The reported risk of major complications from protocol biopsy, including substantial bleeding, macroscopic hematuria with ureteric obstruction, peritonitis, and graft loss, is approximately 1%. 21,22 The reported rates of subclinical rejection varied from 9% to 49% according to the immunologic profile and the . Distinct time frame of progression of transplant glomerulopathy lesions according to the 1 year screening kidney allograft biopsies phenotype.…”

Section: Discussionmentioning

confidence: 99%

Subclinical Rejection Phenotypes at 1 Year Post-Transplant and Outcome of Kidney Allografts

Loupy

Vernerey

Tinel

et al. 2015

Journal of the American Society of Nephrology

258

237

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Kidney allograft rejection can occur in clinically stable patients, but long-term significance is unknown. We determined whether early recognition of subclinical rejection has long-term consequences for kidney allograft survival in an observational prospective cohort study of 1307 consecutive nonselected patients who underwent ABO-compatible, complement-dependent cytotoxicity-negative crossmatch kidney transplantation in Paris (2000Paris ( -2010. Participants underwent prospective screening biopsies at 1 year post-transplant, with concurrent evaluations of graft complement deposition and circulating anti-HLA antibodies. The main analysis included 1001 patients. Three distinct groups of patients were identified at the 1-year screening: 727 (73%) patients without rejection, 132 (13%) patients with subclinical T cell-mediated rejection (TCMR), and 142 (14%) patients with subclinical antibody-mediated rejection (ABMR). Patients with subclinical ABMR had the poorest graft survival at 8 years post-transplant (56%) compared with subclinical TCMR (88%) and nonrejection (90%) groups (P,0.001). In a multivariate Cox model, subclinical ABMR at 1 year was independently associated with a 3.5-fold increase in graft loss (95% confidence interval, 2.1 to 5.7) along with eGFR and proteinuria (P,0.001). Subclinical ABMR was associated with more rapid progression to transplant glomerulopathy. Of patients with subclinical TCMR at 1 year, only those who further developed de novo donor-specific antibodies and transplant glomerulopathy showed higher risk of graft loss compared with patients without rejection. Our findings suggest that subclinical TCMR and subclinical ABMR have distinct effects on long-term graft loss. Subclinical ABMR detected at the 1-year screening biopsy carries a prognostic value independent of initial donor-specific antibody status, previous immunologic events, current eGFR, and proteinuria.

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Section: Discussionmentioning

confidence: 99%

Subclinical Rejection Phenotypes at 1 Year Post-Transplant and Outcome of Kidney Allografts

Loupy

Vernerey

Tinel

et al. 2015

Journal of the American Society of Nephrology

258

237

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“…Of the 2127 biopsy events assessed for major complications and 1486 for minor ones, there were three episodes of hemorrhage and three episodes of peritonitis, and three patients required transfusion. No deaths were observed, and only one graft was lost; all complications presented within 4 h of biopsy (27). Similarly, of 277 renal biopsies that were performed in a single-center study, there was only one (0.4%) serious hemorrhagic complication (28).…”

Section: Safety Of Protocol Biopsiesmentioning

confidence: 91%

Protocol Transplant Biopsies

Wilkinson

2006

Clinical Journal of the American Society of Nephrology

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Studies suggest that surveillance or protocol biopsies that are performed during the first year after kidney transplantation may be clinically useful in identifying early acute rejection or chronic allograft nephropathy at a point when they may be amenable to treatment. Although the benefit of this approach has yet to be evaluated in large, multicenter, prospective trials, numerous studies suggest that implementation of protocol biopsies may improve long-term graft function. In particular, a number of reports suggest that detection of chronic allograft nephropathy in early protocol biopsies is predictive of subsequent graft function and loss and that early treatment may have a dramatic effect on the outcome of the graft. Protocol biopsies also have the potential to be of great value in high-risk patients, such as those with delayed graft function, by allowing for early intervention for acute rejection. Furthermore, the procedure seems to be relatively straightforward and safe. Nevertheless, paucity of data has meant that clear proof of a benefit of early treatment of subclinical rejection and chronic allograft nephropathy detected by protocol biopsy is lacking. Moreover, the optimal timing of protocol biopsies and reliable methods to quantify the histologic changes observed in biopsy specimens have yet to be determined. This review discusses the pros and cons of protocol biopsies and considers the place of this procedure in the routine treatment of kidney transplant patients.

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“…Two recent studies from Europe are reassuring, as they report a low major complication rate (including transfusion requirement and catheterization) of between 0.4 and 1%, with only one graft lost in approximately 2500 biopsies (1,2).…”

mentioning

confidence: 99%

Protocol Transplant Biopsies

Rush¹

2006

Clinical Journal of the American Society of Nephrology

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Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates

Cited by 202 publications

References 11 publications

Subclinical Rejection Phenotypes at 1 Year Post-Transplant and Outcome of Kidney Allografts

Subclinical Rejection Phenotypes at 1 Year Post-Transplant and Outcome of Kidney Allografts

Protocol Transplant Biopsies

Protocol Transplant Biopsies

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