Reliability of chronic allograft nephropathy diagnosis in sequential protocol biopsies

Serón, Daniel; Moreso, Francesc; Fulladosa, Xavier; Hueso, Miguel; Carrera, Marta; Grinyó, Josep M.

doi:10.1046/j.1523-1755.2002.00174.x

Cited by 110 publications

(105 citation statements)

References 22 publications

(3 reference statements)

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“…Similarly, CAN diagnosed in protocol biopsies at 3 and 6 mo has been shown to predict renal allograft function at 2 yr posttransplantation (18). In addition, graft survival was found to be significantly better in patients without CAN versus those with CAN detected in protocol biopsies performed at 4 (91 versus 74%; P Ͻ 0.05) or 14 (94 versus 75%; P Ͻ 0.05) mo (19).…”

Section: Diagnosis Of Can By Protocol Biopsymentioning

confidence: 93%

“…However, Banff criteria were devised to evaluate diagnostic biopsies for which the findings are likely to be more easily interpretable, not protocol biopsies for which the degree of interstitial fibrosis is mild, particularly in early biopsies (0 to 20%) (19). This leads to a high probability of misclassification of biopsies with borderline changes or grade 1 CAN.…”

Section: Reliability Of Scr and Can Diagnosismentioning

confidence: 99%

“…In an additional study, 310 protocol biopsies were obtained from 155 patients at 4 and 14 mo posttransplantation, and lesions were graded according to Banff criteria (19). Graft survival was found to be significantly better in patients without CAN versus those with CAN at both time points (P Ͻ 0.05 for both comparisons), with the incidence of CAN progressing from 40% at month 4 to 53% at month 14.…”

Section: Reliability Of Scr and Can Diagnosismentioning

confidence: 99%

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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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Section: Diagnosis Of Can By Protocol Biopsymentioning

confidence: 93%

Section: Reliability Of Scr and Can Diagnosismentioning

confidence: 99%

Section: Reliability Of Scr and Can Diagnosismentioning

confidence: 99%

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Protocol Transplant Biopsies

Wilkinson

2006

Clinical Journal of the American Society of Nephrology

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“…More recently, a study that examined the progression of chronic histologic changes in serial biopsies concluded that inaccuracies as a result of sampling occur in up to 25% of cases (5). Thus, sampling error, in the diagnosis of both acute and chronic pathology, is a limitation of the biopsy in renal allografts.…”

mentioning

confidence: 99%

Protocol Transplant Biopsies

Rush¹

2006

Clinical Journal of the American Society of Nephrology

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“…This discrepancy between clinical signs of renal failure and histologic findings of rejection confirms the finding in humans that renal allograft biopsies can diagnose subclinical rejection and are an important diagnostic tool for the follow up of renal transplants. 7,13,14,21,26,27 Although the Banff '97 classification was helpful for detecting a rejection, it did not reliably reflect the severity of the reaction. No significant differences were found in serum creatinine concentrations (used as measure for the severity of renal failure) in the different groups of the acute or active (P ϭ 0.942) or chronic (P ϭ 0.282) rejection reactions.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Findings and Classification of Feline Renal Transplants

et al. 2004

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Abstract. Seventy-seven feline transplant kidney specimens, obtained from 1 to 3,183 days (9 years) after transplantation, were reevaluated histologically and classified on the basis of the Banff '97 guidelines for human renal transplant kidneys. Overall, this classification system appeared useful in detecting rejection reactions and confirmed the finding in humans that biopsies can diagnose subclinical rejection and therefore are an important diagnostic tool for the follow up of renal transplants. However, on the basis of serum creatinine values, the severity of the acute or active and chronic lesions was not accurately reflected by this scoring system. This is thought to be due to the significant differences in histologic rejection patterns, especially in acute or active rejection, in cats when compared with humans. Tubulitis, lymphocytic glomerulitis, and vasculitis, which are the main pillars of the Banff '97 acute or active rejection scoring system, are either rare or not found in cats. The presence of significant necrotizing glomerulitis and vasculitis in feline renal transplants might imply that the rejection is complicated by acute antibody-mediated rejection. Alternatively, cyclosporine toxicity also should be considered because some of these kidneys show other signs of cyclosporine toxicity. Finally, the significance of subcapsular and interlobular phlebitis, rarely described in human rejection reactions but a distinct entity in cats, is unknown. From this study, it is clear that there are significant differences in the histology of acute or active rejection between humans and cats and that a better understanding of the histologic appearance of renal allografts will be especially beneficial for treatment and prognostic purposes.

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Reliability of chronic allograft nephropathy diagnosis in sequential protocol biopsies

Cited by 110 publications

References 22 publications

Protocol Transplant Biopsies

Protocol Transplant Biopsies

Protocol Transplant Biopsies

Histopathologic Findings and Classification of Feline Renal Transplants

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