title: An analysis of early renal transplant protocol biopsies--the high incidence of subclinical tubulitis.
abstract: To investigate the possibility that we have been underestimating the true incidence of acute rejection, we began to perform protocol biopsies after kidney transplantation. This analysis looks at the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor kidney transplantation, underwent 277 biopsies. We focused on the subset of biopsies in patients without delayed graft function (DGF) and with stable or improving renal function, who underwent a biopsy 8.2+/-2.6 d (range 3-18 d) after transplantation (n = 28). Six (21%) patients with no DGF and with stable or improving renal function had borderline histopathology, and 7 (25%) had acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was one (0.4%) serious hemorrhagic complication, in a patient receiving low molecular weight heparin; she ultimately recovered and has normal renal function. Her biopsy showed Banff 1B tubulitis. In patients with stable or improving renal allograft function early after transplantation, subclinical tubulitis may be present in a substantial number of patients. This suggests that the true incidence of rejection may be higher than is clinically appreciated.
authors.affiliation: University of Pittsburgh, Thomas E. Starzl Transplantation Institute, PA 15213, USA. shapiror@msx.upmc.edu
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
authors.forename: P
authors.initials: P
authors.lastname: Randhawa
authors.forename: M L
authors.initials: ML
authors.lastname: Jordan
authors.forename: V P
authors.initials: VP
authors.lastname: Scantlebury
authors.forename: C
authors.initials: C
authors.lastname: Vivas
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.forename: R J
authors.initials: RJ
authors.lastname: Corry
authors.forename: J
authors.initials: J
authors.lastname: McCauley
authors.forename: J
authors.initials: J
authors.lastname: Johnston
authors.forename: J
authors.initials: J
authors.lastname: Donaldson
authors.forename: E A
authors.initials: EA
authors.lastname: Gray
authors.forename: I
authors.initials: I
authors.lastname: Dvorchik
authors.forename: T R
authors.initials: TR
authors.lastname: Hakala
authors.forename: J J
authors.initials: JJ
authors.lastname: Fung
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D002102:Cadaver; D006084:Graft Rejection / Q000473:pathology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000473:pathology*; D007684:Kidney Tubules / Q000473:pathology*; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors